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Practicum Script’s model is based on reflexive, self-regulated learning rather than on teaching. It is designed for specialists or senior residents.

When you sign up, you become part of an international collaborative network of clinical thinkers. Members of this virtual club share a passion for the complex intellectual challenges inherent in clinical decision making and for patient-centered clinical debate and controversy.

Practicum Script’s innovative approach means it is constantly evolving toward perfection and has great potential for development. Each participant helps to make the training model more effective.

METHODOLOGY

The contents are elaborated by an international committee of experts within each specialty. Some of these act as authors, providing real cases and organizing them with rigorous methods. Others validate these cases, responding to the clinical challenges and making decisions in doubt-laden contexts in the same way that you do in the simulation.

All the experts reach their decisions individually, not by working together or in consensus, within the maximum time limits, and they explain the reasoning behind their decisions in the different scenarios.

The experts’ decisions are based on their clinical expertise (experience-based medicine) and are complemented with an analysis of the scientific literature using methodological filters (evidence-based medicine). The experts’ responses are grouped to show their agreement and disagreement.

You face the same clinical scenarios presented to the experts and compare and contrast your decisions with theirs, receiving immediate feedback about how your answers agree or disagree with theirs. As the simulation moves forward, you come closer to the target that will accredit your experiential learning (certificate/diploma) while you also distinguish yourself in your specialty’s club of clinical thinkers.

THEORETICAL BASIS

Practicum Script’s program falls within the category known in neuroscience and cognitive psychology as “script theory”.

The neurobiological concept of scripts is based on professionals’ having cognitive structures of knowledge

networks built up through clinical experience, which direct decision-making processes in medical practice.

According to this theoretical model, clinical reasoning takes place in two sequential stages:

In the first, quick-thinking stage (abductive reasoning or "script triggering"), the initial information about the patient immediately gives rise to an automatic, unconscious generation of hypotheses, which are derived from pattern recognition through brain automatisms dependent on prior clinical experience.

In the second, more deliberate stage (hypothetical-deductive reasoning or "script processing"), new information enables alternatives to be compared and contrasted to confirm or rule out the initial hypotheses.

This “dual theory of reasoning” has recently been supported by solid biological evidence from functional neuroimaging, which has found two different anatomic patterns of cortical activation during non-analytical and analytical thought processes involved in clinical decision making.

Analytic thought
No analytic thought

Durning SJ, Costanzo ME, Van Der Vleuten C. Functional neuroimaging correlates of thinking flexibility and knowledge structure in memory: Exploring the relationships between clinical reasoning and diagnostic thinking. Med Teach. 2015 Jun 16:1-8

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