HLTH6181 Diagnostic assessment and decision making (advanced critical care practitioner)
This is a core module within the MSc Advanced Clinical Practice (Advanced Critical Care Practitioner) pathway It enables students to progress from history taking and physical examination to selecting appropriate investigations, analysing clinical findings and diagnostic decision making.
Aims and Objectives
The aim of the module is to support you in developing your skills and knowledge in diagnosis and making decision related to critically ill patients. Building on your previous theoretical and practical experience it will offer you opportunities to advance your practice.
Having successfully completed this module you will be able to:
- Critically explore the concept of clinical diagnosis with reference to history, culture and professional identity.
- Demonstrate the ability to articulate diagnostic reasoning with due reference to underpinning clinical science
- Critically appraise the contribution, accuracy and costs of clinical tests to inform differential diagnoses.
- 4. Demonstrate critical analysis with regard to diagnostic thinking and decision making in complex clinical situations with reference to: a. pathophysiology b. clinical measurement c. epidemiology d. uncertainty e. probability, risk and safety f. critical illness
- Critically appraise the contribution of decision support tools in diagnostic reasoning and decision making for improved health outcomes in critical illness
You will have completed the history taking and physical assessment module which considers health assessment from a broad multi-professional viewpoint, focusing on discrimination of ‘normal’ vs ‘abnormal’ findings. This module will focus more specifically on variants from the normal (the pathophysiological) and explore concepts of diagnosis. Through a variety of learning methods it will bring you into contact with active clinicians and with researchers who are engaged in constructing diagnostic tools. The module is based on the hypothesis that both a quantitative and a qualitative understanding of clinical reasoning and decision making makes for a better diagnostician. Throughout this module you are expected to consider the critically ill patient and how this knowledge and these skills can support your developing role. You will be encouraghed to discuss your learning with your clinical mentor and draw on the diagnostic reasoning and decision making in your clinical practice eunder appropriate supervision. • Definitions and models of clinical diagnosis – historical, cross professional and cross cultural perspectives • Decision making and diagnostic reasoning in the critical care environment • Decision making theory and its application to diagnostic reasoning • The role of clinical testing within an assessment: history, examination and laboratory • Analysing the costs and benefits of clinical testing • The accuracy of diagnostic testing: sensitivity, specificity, predictive value, risk and probability. • Applied clinical life science with a focus on pathophysiology • Clinical testing: haematology, clinical chemistry, microbiology, principles of imaging (including chest x-ray), pathology, functional measurement and cardiovascular investigations (including ECG and Echo) and ultrasound • Designing clinical tools. • Diagnostic reasoning in the critical care environment with emphasis on the altered pathophysiology of the critically ill patient • Critically exploring the importance of clinical context in diagnostic decision making with reference to service users’ perceptions, beliefs, aspirations, concerns, expectations and views.
During this module it is expected that you will be working in clinical practice and therefore have the support of the specialists within your area. During the action learning groups you will be supported to bring together your clinical experience and theoretical knowledge you have gained through the module with particular reference to the critically ill patient.
Learning and Teaching
Teaching and learning methods
• On line materials for life science preparation • Lectures on key themes • Study groups • Blackboard and other on-line materials • Case based clinical scenarios using laboratory results • Clinical mentors in students’ work base • Problem solving workshops designing clinical tools • Facilitated discussion online/professional conversations delivered in the classroom • Locating and using web based resources • Networking with other students via e-mail/discussion board • Work based activities • Literature retrieval and analysis • Guided reading
|Completion of assessment task||47|
|Wider reading or practice||50|
|Preparation for scheduled sessions||30|
|Total study time||250|
Resources & Reading list
McGee S (2012). Evidence Based Physical Diagnosis.
Bernstein A. Soni N. (2013). Oh’s Intensive Care Manual.
Kumar P. and Clark M. (2012). Clinical Medicine.
Thompson C. and Dowding D (2009). Essential Decision making and Clinical Judgement for Nurses.
Fletcher R. Fletcher S, Fletcher G. (2014). Clinical Epidemiology: the essentials.
Llewelyn H. Ang H., Lewis K. and Al-Abdullah A. (2014). Oxford Handbook of Clinical Diagnosis.
Parillo J. Dellinger R. (2013). Critical Care Medicine: Principles of Diagnosis and Management in the Adult.
Bickley, L. (2012). Bates Guide to Physical Examination and History Taking.
Higgins C (2013). Understanding Laboratory Investigations: A guide for nurses and health professionals.
Towards the end of the module there will be a formative multiple choice examination which will be used to enable the teaching team and yourself to assess learning to date and identify further learning needs. This will be in the same format as the summative multiple-choice examination, so this will also give you the opportunity to become familiar with the question/examination format. The summative assessment comprises two parts a) invigilated examination and b) essay. a) Invigilated Examination (30% of total mark.) This will comprise multiple choice questions. It is designed to motivate you to review the factual learning materials on the course and to apply the information to clinical scenarios including critically ill patients. This will require not only recall but also an understanding of some of the key concepts and principles relating to clinical diagnosis, and their application in practice. b) Essay. 2,500 words. (70% of total mark). You will select a clinical case based on a critically ill patient whom you have been involved in their care and with reference to underpinning theory, critically analyse and justify the following: • The process by which you gathered subjective and objective clinical data in the consultation • Your decision making with regard to selected investigations and their value and interpretation • Your processing and integration of all the clinical data to test diagnostic hypotheses. This is a challenging task because you must not only reflect on the case scenario and the diagnostic decisions you took, but additionally, you must critically explore the way in which you processed the clinical data, with reference to diagnostic theory. You will be unable to achieve this without critical thinking and writing skills, and an understanding of the principles of diagnostic reasoning. It is anticipated that for those wishing to apply for Associate Membership with the Faculty of Intensive Care Medicine as an Advanced Critical Care Practitioner that this will form a part of the overall portfolio and therefor it is suggested that this is considered when deciding on a case to write about. Both components will be marked out of 100%. The pass mark for both components is 50%. You must gain a minimum of 50% in each of the two assessment components to pass the module.
Multiple choice question
|Essay (2500 words)||70%|
|Multiple choice question||30%|
Repeat type: Internal & External