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This is a bit of a different post. Hope you find benefit in it.
Currently, I am learning about cognitive and metacognitive strategies to improve reading comprehension and to enhance studying. Some of these strategies involve prediction, generating ideas, and elaboration.
Since I see a significant parallel between these strategies and clinical practice, I am writing a paper on it. I thought I would start this discussion as this relates to the formative assessments we are having you do.
Let’s keep this light so instead of reading articles, I linked a couple of videos I came across during my research on this topic.
Watch these 2 videos. Watch the slinky video first (but only the first 3’25”) before the Reading prediction video. Post your thoughts on how you feel (if you feel) this relates to clinical practice and the things your mentor asks of you during debriefs as we help improve your clinical reasoning and clinical pattern recognition. Cite any specific parallels you see. -
This is so cool!! I love what he said – “sometimes you need to believe it to see it.” This is totally applicable to what we do. Sometimes, we just need to believe that we are doing the technique correctly and believe that what we are trying to do is actually happening. I also think it’s interesting that you have to first commit to a prediction in order to learn something. This makes the process way more active – the metacognition, or thinking about your thinking, needs to be an active process to get something out of it.
The second video – this is clinical reasoning at it’s finest, right? We start to look at things with patients (how they present, what they say) and start to form predictions about what we will find (limited range of motion, hyporeflexia) and then we check our predictions as we continue examining. As we get better at it, our predictions are more likely to be accurate and we start to pick up on patterns and learn on our past knowledge about the presentations more.
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I think the biggest parallel I see is you have to commit/predict to something before you go into your objective exam. I had a patient who seemed cervical radiculopathy, but there were some question marks. I still committed to that as the primary, but when rotation, spurling’s, and extension were negative, I was able to think in the moment that this isn’t what I expected and therefore might not be what I think it is. If I hadn’t predicted what I would see, I think I would have collected all the data and then reflected at the end of what it could be instead of doing it more within the moment.
I think that the act of making a prediction makes you invested and gives you something meaningful to engage with. It forces you to be thoughtful during the entire process.
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I agree with Helen, the slinky video is pretty cool. I think these videos reiterate a lot of the things Eric and I discuss in our session debriefs, especially the part about how education isn’t just reading something from the book and then bam it’s in your brain. We have talked so much about how associating a specific patient and what their presentation looks like/sounds like will help me to really cement that diagnosis presentation in my head and help me improve with recognizing the patterns with different conditions. I also like how the slinky guy talks about how the student-teacher relationship is as important in the learning process as the student-student relationship. I feel like having Eric there to push me and make me think about things in a different light is just as important as me having Anna there to ask my dumb questions to and just bounce ideas off of in general.
Like Barrett and Helen said, I think going into an eval with a prediction makes a world of difference. I feel like having that prediction gives me a better starting point to organize my thoughts and guides my line of questions better, although this is definitely still a work in progress for me.
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Great resources and well worth the few minutes to take a look at and think about.
From the slinky video a few specific quotes stood out to me 1) “scientific research has shown that if you don’t make a prediction, what you learned from [this] will be no more than if you never saw [this] at all” and 2) “sometimes you need to know what is there, what you are actually looking for, before you see it.”
Some of my take home points from the reading prediction video:
– Prediction allows us to think ahead about what may occur and also create our own ideas; it increases our engagement
– Prediction before- based on current information/presentation and prior knowledge
– Prediction during- reflection on what has happened and predict what will happen based on this
– Prediction afterwards- reflection at the end to check the accuracy of your original prediction and evolution of your prediction
– Confirm your predictions based on what you already know to help comprehend what is going to happenPrimary hypothesis and differential diagnoses could just as easily be called predictions. Clinical practice is all about making predictions, challenging your predictions throughout, and reflecting during and after patient encounters to see if your prediction was right and/or how it was different or the same from what you expected. These concepts for sure tie into the formative assignments, clinical reasoning form, and discussions during mentorship time. All of these things help to be a critical thinker before, during, and after, and through using this process enhance learning from these situations. The second quote I mentioned from the slinky video also makes me think of clinical pattern recognition and how you need some sort of framework to make sense of findings in order to them to be relevant to you.
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What resonated with me most were the few sentences about committing to an idea. I believe this parallels nicely with committing to the post-subjective and -objective hypothesis. This act of committing has been a portion in my examination that I have been honing in on, as it is easy to become wishy-washy. My worries of incorrectly hypothesizing have often led to more confusion than helpfulness, and as the video states, “If you don’t make a prediction, what you will learn from this will be no more than if you had never seen this at all”. By not committing, we lose out on our ability to clinically reason and develop pattern recognition. It is likely more important to realize that the information we have gathered is inconsistent with our hypothesis, rather than retrospectively attempting to make sense of it.
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The slinky video was very interesting and made a lot of good points. One of the biggest take away was when he said “If you don’t make a prediction, what you learn from this will be no more than if you never saw this at all.” This resonates with me because, this reinforces an active learning style which is how I learn best. Another take home message was at the end when he was talking about having to believe it before you see it rather than the old saying, see it to believe it. I think this has major implications with clinical reasoning. For example, researching and being able to identify patterns for specific diagnoses can help identify and create PT diagnoses for future patients. Another way that this has implications to clinical reasoning is that if you can create a prediction, based on previous experience and knowledge before and during the evaluation, you will learn from the experience a lot more than if you were to just complete the evaluation and retroactively try and diagnose.
The second video about predictions also had a lot of good points. Using contextual clues as well as clues from previous experiences is very important in clinical reasoning. As mentioned above, being able to use these clues is essential for not only creating but using the patterns to help with clinical reasoning.
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One thing I took from this video was the importance of committing to a hypothesis. Watching the prediction video made me reflect on my previous experiences learning about predictive processing and Bayes’ Theorem. Essentially, these ideas are centered around the idea that we are constantly updating our hypotheses with new information as it is presented to us and it is synthesized with our past knowledge. This way of thinking can be very helpful as stated in the video, but how can you update your hypothesis if there isn’t anything there in the first place? In order to change a belief you have to have one.
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