Understanding higher-order constructs of leadership and communication in EMS clinical judgment
Abstract Background For emergency medical services (EMS) clinicians, clinical judgment is a higher-order construct that encompasses the initial thought process (clinical reasoning) that assists clinicians in reaching conclusions (clinical decision making). Current theoretical frameworks of clinical...
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| Format: | Article |
| Language: | English |
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BMC
2024-11-01
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| Series: | BMC Medical Education |
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| Online Access: | https://doi.org/10.1186/s12909-024-06282-5 |
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| author | Mihaiela R. Gugiu Jennifer Cotto Yin Burgess Jonathan Powell Ashish R. Panchal |
| author_facet | Mihaiela R. Gugiu Jennifer Cotto Yin Burgess Jonathan Powell Ashish R. Panchal |
| author_sort | Mihaiela R. Gugiu |
| collection | DOAJ |
| description | Abstract Background For emergency medical services (EMS) clinicians, clinical judgment is a higher-order construct that encompasses the initial thought process (clinical reasoning) that assists clinicians in reaching conclusions (clinical decision making). Current theoretical frameworks of clinical judgment contain other higher order constructs (e.g., leadership, communication) which may play a significant role in delivery of care. It is unknown whether this definition of clinical judgment includes additional higher order constructs of leadership and communication. The goal of this evaluation was to determine whether leadership and communication overlap and are subsumed under the larger construct of clinical judgment. Methods Focus groups of experts in prehospital paramedic and advanced emergency medical technician levels of certification were recruited to generate tasks and their associated knowledge, skills, and abilities (KSAs) in for the domains of clinical judgment, communication, and leadership. These tasks and KSAs were then evaluated for commonality between the domains to evaluate whether communication and leadership are incorporated within clinical judgment. Results Task-KSA matrices were generated by focus groups for each domain and evaluated by certification level. There were no differences by certification level in the tasks-KSA matrices for the domains. A total of 77 tasks were identified, comprised of 392 KSAs across three domains (9 sub-domains). An analysis of commonality of tasks between the domains of communication and leadership with clinical judgment demonstrated that 61% of communication tasks were similar to the identified clinical judgment tasks. Similarly, in leadership, clinical judgment had a total of 79% commonality overall. Conclusion Clinical judgment was found to be a higher order construct that overlaps with and incorporates the domains of leadership and communication in the theoretical framework of EMS clinical judgment. This study provides validity evidence for the proposed clinical judgment theoretical framework. Future work should focus on pilot evaluations in simulated settings for building additional construct validity. |
| format | Article |
| id | doaj-art-2d795829abfe4633bf04dbdcd2d187b1 |
| institution | OA Journals |
| issn | 1472-6920 |
| language | English |
| publishDate | 2024-11-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Medical Education |
| spelling | doaj-art-2d795829abfe4633bf04dbdcd2d187b12025-08-20T02:33:06ZengBMCBMC Medical Education1472-69202024-11-012411910.1186/s12909-024-06282-5Understanding higher-order constructs of leadership and communication in EMS clinical judgmentMihaiela R. Gugiu0Jennifer Cotto1Yin Burgess2Jonathan Powell3Ashish R. Panchal4National Registry of Emergency Medical TechniciansNational Registry of Emergency Medical TechniciansNational Registry of Emergency Medical TechniciansNational Registry of Emergency Medical TechniciansNational Registry of Emergency Medical TechniciansAbstract Background For emergency medical services (EMS) clinicians, clinical judgment is a higher-order construct that encompasses the initial thought process (clinical reasoning) that assists clinicians in reaching conclusions (clinical decision making). Current theoretical frameworks of clinical judgment contain other higher order constructs (e.g., leadership, communication) which may play a significant role in delivery of care. It is unknown whether this definition of clinical judgment includes additional higher order constructs of leadership and communication. The goal of this evaluation was to determine whether leadership and communication overlap and are subsumed under the larger construct of clinical judgment. Methods Focus groups of experts in prehospital paramedic and advanced emergency medical technician levels of certification were recruited to generate tasks and their associated knowledge, skills, and abilities (KSAs) in for the domains of clinical judgment, communication, and leadership. These tasks and KSAs were then evaluated for commonality between the domains to evaluate whether communication and leadership are incorporated within clinical judgment. Results Task-KSA matrices were generated by focus groups for each domain and evaluated by certification level. There were no differences by certification level in the tasks-KSA matrices for the domains. A total of 77 tasks were identified, comprised of 392 KSAs across three domains (9 sub-domains). An analysis of commonality of tasks between the domains of communication and leadership with clinical judgment demonstrated that 61% of communication tasks were similar to the identified clinical judgment tasks. Similarly, in leadership, clinical judgment had a total of 79% commonality overall. Conclusion Clinical judgment was found to be a higher order construct that overlaps with and incorporates the domains of leadership and communication in the theoretical framework of EMS clinical judgment. This study provides validity evidence for the proposed clinical judgment theoretical framework. Future work should focus on pilot evaluations in simulated settings for building additional construct validity.https://doi.org/10.1186/s12909-024-06282-5Emergency medical servicesClinical judgmentClinical reasoningDecision-makingLeadershipCommunication |
| spellingShingle | Mihaiela R. Gugiu Jennifer Cotto Yin Burgess Jonathan Powell Ashish R. Panchal Understanding higher-order constructs of leadership and communication in EMS clinical judgment BMC Medical Education Emergency medical services Clinical judgment Clinical reasoning Decision-making Leadership Communication |
| title | Understanding higher-order constructs of leadership and communication in EMS clinical judgment |
| title_full | Understanding higher-order constructs of leadership and communication in EMS clinical judgment |
| title_fullStr | Understanding higher-order constructs of leadership and communication in EMS clinical judgment |
| title_full_unstemmed | Understanding higher-order constructs of leadership and communication in EMS clinical judgment |
| title_short | Understanding higher-order constructs of leadership and communication in EMS clinical judgment |
| title_sort | understanding higher order constructs of leadership and communication in ems clinical judgment |
| topic | Emergency medical services Clinical judgment Clinical reasoning Decision-making Leadership Communication |
| url | https://doi.org/10.1186/s12909-024-06282-5 |
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