OBJECTIVE: To explore and describe acute care nurses\' decisions to recognise and respond to improvement in patients\' clinical states as they occurred in the real-world clinical environment.
METHODS: A descriptive study.
METHODS: Nine medical and eleven surgical nurses in a large Australian metropolitan hospital were individually observed during nurse-patient interactions and followed up in interview to describe their reasoning and clinical judgements behind observed decisions. Verbal description of observations and interviews were recorded and transcribed. Reflexive thematic analysis was used to analyse the data.
RESULTS: The three themes constructed from the data were as follows: nurses checking in; nurses reaching judgements about improvements; and nurses deciding on the best person to respond. Acute care nurses made targeted assessment decisions based on predicted safety risks related to improvement in clinical states. Subjective and objective cues were used to assess for and make judgements about patient improvement. Acute care nurses\' judgment of patient safety and a desire to promote patient centred care guided their decisions to select the appropriate person to manage improvement.
CONCLUSIONS: The outcomes of this research have demonstrated that the proven safety benefits of acute care nurses\' decision making in response to deterioration extend to improvement in patients\' clinical states. In response to improvement, acute care nurses\' decisions protect patients from harm and promote recovery.
CONCLUSIONS: Early recognition and response to improvement enable acute care nurses to protect patients from risks of unnecessary treatment and promote recovery.
CONCLUSIONS: This study makes explicit nurses\' essential safety role in recognising and responding to improvement in patients\' clinical states. Healthcare policy and education must reflect the equal importance of assessment for and management of deterioration and improvement to ensure patients are protected and provided with safe care.

Video recordings of oncology interviews reveal how doctors rely on worry to establish medical expertise, facilitate treatment decision-making, and construct worry parameters to help patients understand whether there is a reasonable need for worry or not. Doctors express worry as frequently as cancer patients during oncology interviews, but they face a dilemma: how to provide care for cancer patients without directly stating they are worried about them? Plausible explanations are offered for why doctors do not state personal worries. Conversation analytic methods were employed to identify how doctors rely on worry to achieve distinct social actions. Four worry formulations are examined: (1) variations of \"we worry\" (and at times, non-specific and second person \"you\"), (2) hypothetical worry scenarios, (3) dismissing worry and offering assurance, and (4) doctors claiming they are not worried, bothered, or alarmed. Doctors align with and speak for the professionals and institutions they represent, expressing collective worries and claiming the legitimate right to worry (or not). Doctors also avoid abandoning patients to their own decision-making, yet do not formulate worry to coerce deference or dictate patients\' choices. In all cases patients agreed and displayed minimal resistance to doctors\' worry formulations. These findings contribute to ongoing work across institutional settings where participants have been shown to construct objective, legitimate claims meriting worries about diverse problems. Work is underway to examine when and how patients explicitly raise and doctors respond to cancer worries. Clinical implications are raised for how doctors can use worry to legitimize best treatment options, help patients minimize their worries, rely on hypothetical scenarios allowing patients to compare how other patients managed their cancer, and not dismiss the importance of minimizing the need to worry as a resource for offering reassurance.

Chronic cerebrospinal fluid leak with spinal cord compression can mimic the symptoms of ALS, with a snake-eyes appearance on MRI.

Medical educators have adopted a number of teaching-learning methodologies to make their sessions interactive considering the need for active engagement of students to strengthen the process of learning. One among them is the use of serious games, wherein digital applications are used to enable the attainment of the intended learning objectives. A wide range of serious games can be designed to target different areas in healthcare training, which cumulatively provide a holistic and engaging approach for students to acquire knowledge and develop skills. Owing to the extensive areas and domains in medical education wherein we can use serious games, the benefits attributed to them are immense. The successful introduction of serious games into the medical curriculum depends on several factors and we must adopt a systematic approach to optimize the benefits. In conclusion, the introduction of serious games into medical education can benefit medical students by helping them master multiple skills required for successful clinical practice. Acknowledging the changing landscapes in medical education, there is an immense need that teachers and administrators to explore the possibility of integrating these games into medical schools.

Diagnostic errors are prevalent in critical care practice and are associated with patient harm and costs for providers and the healthcare system. Patient complexity, illness severity, and the urgency in initiating proper treatment all contribute to decision-making errors. Clinician-related factors such as fatigue, cognitive overload, and inexperience further interfere with effective decision-making. Cognitive science has provided insight into the clinical decision-making process that can be used to reduce error. This evidence-based review discusses ten common misconceptions regarding critical care decision-making. By understanding how practitioners make clinical decisions and examining how errors occur, strategies may be developed and implemented to decrease errors in Decision-making and improve patient outcomes.

BACKGROUND: Research on diagnostic reasoning has been conducted for fifty years or more. There is growing consensus that there are two distinct processes involved in human diagnostic reasoning: System 1, a rapid retrieval of possible diagnostic hypotheses, largely automatic and based to a large part on experiential knowledge, and System 2, a slower, analytical, conscious application of formal knowledge to arrive at a diagnostic conclusion. However, within this broad framework, controversy and disagreement abound. In particular, many authors have suggested that the root cause of diagnostic errors is cognitive biases originating in System 1 and propose that educating learners about the types of cognitive biases and their impact on diagnosis would have a major influence on error reduction.
OBJECTIVE: In the present paper, we take issue with these claims.
METHODS: We reviewed the literature to examine the extent to which this theoretical model is supported by the evidence.
RESULTS: We show that evidence derived from fundamental research in human cognition and studies in clinical medicine challenges the basic assumptions of this theory-that errors arise in System 1 processing as a consequence of cognitive biases, and are corrected by slow, deliberative analytical processing. We claim that, to the contrary, errors derive from both System 1 and System 2 reasoning, that they arise from lack of access to the appropriate knowledge, not from errors of processing, and that the two processes are not essential to the process of diagnostic reasoning.
CONCLUSIONS: The two processing modes are better understood as a consequence of the nature of the knowledge retrieved, not as independent processes.

OBJECTIVE: Interpretation of dental radiographs is a difficult process, particularly for inexperienced students. This study introduced concept mapping for dental students to help in the radiographic interpretation of common jaw lesions. We aimed to analyze the efficacy of the concept map (CM) in radiographic interpretation, with a discussion of the diagnostic reasoning dilemma.
METHODS: This study included 39 dental students. After a 1-h class for CM guidance and based on three group discussions and one-on-one feedback, the students completed and submitted CMs for three jaw diseases (ameloblastoma, odontogenic keratocyst, and simple bone cyst). All participants underwent a pretest and posttest of knowledge and diagnosis; all students but one completed an open-ended questionnaire regarding the use of CMs.
RESULTS: Concept mapping effectively improved diagnostic accuracy. The participants\' posttest scores were better than their pretest scores in both knowledge and diagnostic tests. Most of the students attempted radiographic interpretation through analytic reasoning. The time required for the students to draw a CM varied from student to student from 3-5 h to 1-3 days.
CONCLUSIONS: This study shows that CMs can improve the radiographic diagnostic ability of dental students by providing a framework for analytic reasoning. Continuous research is warranted to improve the effectiveness of CM in oral radiographic interpretation in the dental student\'s class.

UNASSIGNED: Management reasoning is a distinct subset of clinical reasoning. We sought to explore features to be considered when designing assessments of management reasoning.
UNASSIGNED: This is a hybrid empirical research study, narrative review, and expert perspective. In 2021, we reviewed and discussed 10 videos of simulated (staged) physician-patient encounters, actively seeking actions that offered insights into assessment of management reasoning. We analyzed our own observations in conjunction with literature on clinical reasoning assessment, using a constant comparative qualitative approach.
UNASSIGNED: Distinguishing features of management reasoning that will influence its assessment include management scripts, shared decision-making, process knowledge, illness-specific knowledge, and tailoring of the encounter and management plan. Performance domains that merit special consideration include communication, integration of patient preferences, adherence to the management script, and prognostication. Additional facets of encounter variation include the clinical problem, clinical and nonclinical patient characteristics (including preferences, values, and resources), team/system characteristics, and encounter features. We cataloged several relevant assessment approaches including written/computer-based, simulation-based, and workplace-based modalities, and a variety of novel response formats.
UNASSIGNED: Assessment of management reasoning could be improved with attention to the performance domains, facets of variation, and variety of approaches herein identified.

Numerous studies have demonstrated that our healthcare systems and medical education programs are fundamentally flawed. In North America and Europe, most systems were built upon values and structures that have historically benefitted middle and upper class males of European descent in the global north. As a result, there continue to be systemic biases that are pervasive throughout our healthcare systems and medical education programs. This has led to inequities in health outcomes and clinical reasoning practices which marginalize several communities. These biases are perpetuated as we continue to lead medical education research and practice with traditional values and views of evidence. To address these issues, we proposed a \'flipped\' conference in which three interdisciplinary writing teams, comprised of both junior and senior academics, clinicians, and researchers, were invited to rethink the foundations of clinical reasoning. In the months leading up to the conference, each writing team explored a specific topic related to clinical reasoning and racial equity. The papers, presented during the virtual conference are now available in this issue of the Journal for the Evaluation of Clinical Practice. In addition, 6 more publications were added to this special topic to showcase new evidence and theory that builds on the recommendations in the three core papers.

Dyspnea can be found as a symptom of a wide range of diseases. Clinical thinking usually leads us to more common or frequent syndromes and diseases. This case report alerts us to keep investigating when faced with therapeutic failure or the arising of new symptoms. The subject in this case had dyspnea as an initial presentation of his disease and was treated initially as a case of heart dysfunction. Nevertheless, because his symptoms did not respond to the treatment and even got worse, he was sent to the emergency room where he was medicated and discharged with the same diagnostic hypothesis. In light of a new characteristic symptom - ptosis - the hospital team expanded its clinical and laboratory investigation to neuromuscular diseases, reaching out the diagnosis of myasthenia gravis.