I described a gap between DOING and TEACHING reasoning
All of us DO reasoning every day
TEACHING what we DO is hard unless we
✔️have vocabulary to describe it
✔️know how to describe a process
✔️are ok being vulnerable in front of others
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How do we make an invisible process (reasoning), visible?
Step 1: use specific words to describe steps to the cognitive process:
Problem representation
Schema
Illness scripts
Speaking these words signals their importance to your learners - use them!
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Step 2: engage in a Cognitive Apprenticeship
An evolution of the traditional apprenticeship, CA emphasizes narrated thinking in many forms to develop reasoning skills
Not unique to medicine, but applicable
Many techniques within CA - these 3 are money
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Applied to teaching reasoning:
💥Thinking aloud shows how reasoning happens
💥Coaching lets you observe and give real-time feedback
💥Reflection helps build plans for improvement
Drs. Bearman and Molloy teach that I.S. is the way we expose uncertainty to our learners to model growth
@LiangRhea made me aware of this term 🙏🌹 @CPSolvers builds their culture around it ("I don't know!")❤️
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Becoming comfortable with being UNcomfortable is how we go from projecting our uncertainty on our learners to showing learners how WE find and fill our gaps in knowledge and reasoning
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The gap between DOING and TEACHING reasoning is understandably large, but by remembering that reasoning is a process, we can take steps to define, shrink, and even bridge that gap
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Taking a page from @gradydoctor's book, so much gratitude for these humans for giving me opportunity and trust, role-modeling excellence, and teaching me new things. You are all gems 🙏🌹❤️
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For more, including inspiration behind the title and some worked examples, I'm happy to give the full version of this talk in-person or remotely!
1/#meded chalk talks typically deliver FOCUSED teaching in a short amount of time. While venues vary, we’ve probably encountered them in conference, rounds, or in the afternoon post-rounds/lunch.
Where have you encountered chalk talks most frequently?
2/First some general thoughts:
-Keep them short: limit yourself to <10 mins. On rounds? <2 minutes
-Tools: a sheet of paper or a dry erase marker in your pocket
-Bite-sized: even 1 or 2 pearls works! More later (s/o #BSTMode)
-Patient-focused: more engaging
I saw a number of patients with polycythemia recently, so for this #tweetorial, we’ll look at it from a generalist’s perspective and describe a schema algorithmically. Let’s go!
1/First, let’s remind ourselves that polycythemia itself isn’t a diagnosis. Like many things, it is a condition with an underlying cause.
How we define polycythemia:
-Male: Hb>16.5 g/dL, Hct>49%
-Female: Hb>16.0 g/dL, Hct>48%
2/But wait! Remember that a one-off value won’t cut it. Tempo and delta are key to dx.
Look back in the chart. Is this new or a trend? If new, make sure you check at least one additional Hb AND make sure to account for potential hemoconcentration.
Super proud of Dan Corbally, PGY2 @ucsdim. Stellar work writing this @hdx case!
1/ Spoiler alert:
This case forced me to re-think my schema for mesenteric ischemia.
Read on:
@ucsdim@hdx 2/
I used to think of mesenteric ischemia as a diagnosis, but now think of it as a syndrome resulting from an underlying disease process.
So, what processes can result in occlusion/ischemia of mesenteric vessels?
(Disclaimer: focusing on arterial ischemia)
@ucsdim@hdx 3/
Schema/disease categories for mesenteric ischemia:
- Thromboembolism (things that block arteries)
- Hypoperfusion (things that reduce blood flow without occlusion)
- Inflammation (things that can result in the above two)