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Improving Students’ Patient Care Management Using the Thinker’s Guide to Clinical Reasoning

Course Number: 551

Clinical Scenario

The following clinical scenario allows practice in applying the intellectual standards and the elements of clinical reasoning into student training to improve patient care.

  • Patient education clinical scenario with discussion questions: Patient Education: A female client/patient aged 50 years, presented with a moderate caries risk, xerostomia due to medications, and one cavity. During patient education, the student provided brushing and flossing instructions but did not discuss the role of bacteria in the development of the cavity, the moderate risk for decay, and did not work with the patient to set goals of using fluoride to reduce caries risk. The student did include in the treatment notes that the patient used the modified bass technique when brushing twice a day and did not floss regularly. The student encouraged the patient to floss every day. The dental hygiene diagnosis was sound and functional dentition due to lack of flossing and medications as evidenced by the patient’s plaque index of 68% and the patient’s report that her mouth was dry throughout the day and night.

    • What is the problem? (Write out the problem clearly and precisely, with details.)

    • The problem is…

    • Using the Paul-Elder Framework, what questions will you ask the student to encourage clinical reasoning?

      • Purpose:

      • Question:

      • Information:

      • Interpretation and Inference:

      • Concepts:

      • Assumptions:

      • Implications and Consequences:

      • Points of View:

  • What are the challenges in using the framework and how can an educator overcome them? Answers: The problem is the student failed to educate the patient about their risks for caries and periodontal disease and did not collaborate with the patient to set goals to reduce the risks. Using the Thinker’s Guide to Clinical Reasoning, the educator can consider asking the student the following questions to address the problem: What are you trying to accomplish? What is the central question you are trying to think through to address the problem? What facts, data, or evidence do you need to address the problem? What concepts influenced your thinking? What are you taking for granted that forms your thinking? What are the connections and conclusion you are making? What are the consequences of not educating the patient of their risks and not helping the patient set goals? What are the relevant perspectives to consider in addressing the problem?