Clinical reasoning of medical students in a public university in Brazil

The aim of this research was to understand the reasoning developed by medical students in a public university in Brazil. This research on education included semi-structured interviews and film recordings of interns discussing 10 clinical cases. A sample of 16 interns analyzed cases presented on a notebook computer with a webcam. They were instructed to verbalize all their thoughts on the procedures they would use. The film recordings and transcripts of the interviews were analyzed. Quantitative data was evaluated using Yates' chi-squared test and speech analysis was used to evaluate the transcripts. The theme worked on in the practice of reasoning was: the student's perceptions of their clinical practice. Of the 160 diagnoses, 57% were done with analytical reasoning and 43% with non-analytical reasoning. The hypothetical deductive method was employed by 31% of the interns and the inductive method was employed by 69%. The diagnostic accuracy was 81% correct for easy cases and 85% correct for difficult cases. We observed two empirical categories: the cognitive universe of the student and the patient's context.

A hybrid case adaptation approach for case-based reasoning

Case-Based Reasoning is a methodology for problem solving based on past experiences. This methodology tries to solve a new problem by retrieving and adapting previously known solutions of similar problems. However, retrieved solutions, in general, require adaptations in order to be applied to new contexts. One of the major challenges in Case-Based Reasoning is the development of an efficient methodology for case adaptation. The most widely used form of adaptation employs hand coded adaptation rules, which demands a significant knowledge acquisition and engineering effort. An alternative to overcome the difficulties associated with the acquisition of knowledge for case adaptation has been the use of hybrid approaches and automatic learning algorithms for the acquisition of the knowledge used for the adaptation. We investigate the use of hybrid approaches for case adaptation employing Machine Learning algorithms. The approaches investigated how to automatically learn adaptation knowledge from a case base and apply it to adapt retrieved solutions. In order to verify the potential of the proposed approaches, they are experimentally compared with individual Machine Learning techniques. The results obtained indicate the potential of these approaches as an efficient approach for acquiring case adaptation knowledge. They show that the combination of Instance-Based Learning and Inductive Learning paradigms and the use of a data set of adaptation patterns yield adaptations of the retrieved solutions with high predictive accuracy.

Learning by inductive inference /

"Invited paper for the NATO Advanced Study Institute Seminar on Computer Oriented Learning Processes, Aug. 26-Sept. 7, 1974, Bonas, France."

Contradictory reasoning network:an EEG and FMRI study

Contradiction is a cornerstone of human rationality, essential for everyday life and communication. We investigated electroencephalographic (EEG) and functional magnetic resonance imaging (fMRI) in separate recording sessions during contradictory judgments, using a logical structure based on categorical propositions of the Aristotelian Square of Opposition (ASoO). The use of ASoO propositions, while controlling for potential linguistic or semantic confounds, enabled us to observe the spatial temporal unfolding of this contradictory reasoning. The processing started with the inversion of the logical operators corresponding to right middle frontal gyrus (rMFG-BA11) activation, followed by identification of contradictory statement associated with in the right inferior frontal gyrus (rIFG-BA47) activation. Right medial frontal gyrus (rMeFG, BA10) and anterior cingulate cortex (ACC, BA32) contributed to the later stages of process. We observed a correlation between the delayed latency of rBA11 response and the reaction time delay during inductive vs. deductive reasoning. This supports the notion that rBA11 is crucial for manipulating the logical operators. Slower processing time and stronger brain responses for inductive logic suggested that examples are easier to process than general principles and are more likely to simplify communication. © 2014 Porcaro et al.

Inductive Theorem Proving and Computer Algebra in the Mathweb Software Bus

Reasoning systems have reached a high degree of maturity in the last decade. However, even the most successful systems are usually not general purpose problem solvers but are typically specialised on problems in a certain domain. The MathWeb SOftware Bus (Mathweb-SB) is a system for combining reasoning specialists via a common osftware bus. We described the integration of the lambda-clam systems, a reasoning specialist for proofs by induction, into the MathWeb-SB. Due to this integration, lambda-clam now offers its theorem proving expertise to other systems in the MathWeb-SB. On the other hand, lambda-clam can use the services of any reasoning specialist already integrated. We focus on the latter and describe first experimnents on proving theorems by induction using the computational power of the MAPLE system within lambda-clam.

Weak reasoning argumentative theory. A dialogical approach for the discovery of philosophy in high schools

In the literature on philosophical practices, despite the crucial role that argumentation plays in these activities, no specific argumentative theories have ever been proposed to assist the figure of the facilitator in conducting philosophical dialogue and to enhance student’s critical thinking skills. The dissertation starts from a cognitive perspective that challenges the classic Cartesian notion of rationality by focusing on limits and biases of human reasoning. An argumentative model (WRAT – Weak Reasoning Argumentative Theory) is then outlined in order to respond to the needs of philosophical dialogue. After justifying the claim that this learning activity, among other inductive methodologies, is the most suitable for critical thinking education, I inquired into the specific goal of ‘arguing’ within this context by means of the tools provided by Speech Act Theory: the speaker’s intention is to construct new knowledge by questioning her own and other’s beliefs. The model proposed has been theorized on this assumption, starting from which the goals, and, in turn, the related norms, have been pinpointed. In order to include all the epistemic attitudes required to accomplish the complex task of arguing in philosophical dialogue, I needed to integrate two opposed cognitive accounts, Dual Process Theory and Evolutionary Approach, that, although they provide incompatible descriptions of reasoning, can be integrated to provide a normative account of argumentation. The model, apart from offering a theoretical contribution to argumentation studies, is designed to be applied to the Italian educational system, in particular to classes in technical and professional high schools belonging to the newly created network Inventio. This initiative is one of the outcomes of the research project by the same name, which also includes an original Syllabus, research seminars, a monitoring action and publications focused on introducing philosophy, in the form of workshop activities, into technical and professional schools.

Improving Critical Thinking and Clinical Reasoning With a Continuing Education Course

Background: Continuing education courses related to critical thinking and clinical reasoning are needed to improve the accuracy of diagnosis. Method: This study evaluated a 4-day, 16-hour continuing education course conducted in Brazil. Thirty-nine nurses completed a pretest and a posttest consisting of two written case studies designed to measure the accuracy of nurses` diagnoses. Results: There were significant differences in accuracy from pretest to posttest for case 1 (p = .008) and case 2 (p = .042) and overall (p = .001). Conclusion: Continuing education courses should be implemented to improve the accuracy of nurses` diagnoses. J Contin Educ Nurs 2009;40(3):121-127.

The frontal assessment battery (FAB) reveals neurocognitive dysfunction in substance-dependent individuals in distinct executive domains: Abstract reasoning, motor programming, and cognitive flexibility

Substance-dependence is highly associated with executive cognitive function (ECF) impairments. However. considering that it is difficult to assess ECF clinically, the aim of the present study was to examine the feasibility of a brief neuropsychological tool (the Frontal Assessment Battery FAB) to detect specific ECF impairments in a sample of substance-dependent individuals (SDI). Sixty-two subjects participated in this study. Thirty DSM-IV-diagnosed SDI, after 2 weeks of abstinence, and 32 healthy individuals (control group) were evaluated with FAD and other ECF-related tasks: digits forward (DF), digits backward (DB), Stroop Color Word Test (SCWT), and Wisconsin Card Sorting Test (WCST). SDI did not differ from the control group on sociodemographic variables or IQ. However, SDI performed below the controls in OF, DB, and FAB. The SDI were cognitively impaired in 3 of the 6 cognitive domains assessed by the FAB: abstract reasoning, motor programming, and cognitive flexibility. The FAB correlated with DF, SCWT, and WCST. In addition, some neuropsychological measures were correlated with the amount of alcohol, cannabis, and cocaine use. In conclusion, SDI performed more poorly than the comparison group on the FAB and the FAB`s results were associated with other ECF-related tasks. The results suggested a negative impact of alcohol, cannabis, and cocaine use on the ECF. The FAB may be useful in assisting professionals as an instrument to screen for ECF-related deficits in SDI. (C) 2010 Elsevier Ltd. All rights reserved.

Reasoning about real-time repetitions: terminating and nonterminating

It is common for a real-time system to contain a nonterminating process monitoring an input and controlling an output. Hence, a real-time program development method needs to support nonterminating repetitions. In this paper we develop a general proof rule for reasoning about possibly nonterminating repetitions. The rule makes use of a Floyd-Hoare-style loop invariant that is maintained by each iteration of the repetition, a Jones-style relation between the pre- and post-states on each iteration, and a deadline specifying an upper bound on the starting time of each iteration. The general rule is proved correct with respect to a predicative semantics. In the case of a terminating repetition the rule reduces to the standard rule extended to handle real time. Other special cases include repetitions whose bodies are guaranteed to terminate, nonterminating repetitions with the constant true as a guard, and repetitions whose termination is guaranteed by the inclusion of a fixed deadline. (C) 2002 Elsevier Science B.V. All rights reserved.

Assessing clinical reasoning: a method to monitor its development in a PBL curriculum

The aim of this study was to develop and trial a method to monitor the evolution of clinical reasoning in a PBL curriculum that is suitable for use in a large medical school. Termed Clinical Reasoning Problems (CRPs), it is based on the notion that clinical reasoning is dependent on the identification and correct interpretation of certain critical clinical features. Each problem consists of a clinical scenario comprising presentation, history and physical examination. Based on this information, subjects are asked to nominate the two most likely diagnoses and to list the clinical features that they considered in formulating their diagnoses, indicating whether these features supported or opposed the nominated diagnoses. Students at different levels of medical training completed a set of 10 CRPs as well as the Diagnostic Thinking Inventory, a self-reporting questionnaire designed to assess reasoning style. Responses were scored against those of a reference group of general practitioners. Results indicate that the CRPs are an easily administered, reliable and valid assessment of clinical reasoning, able to successfully monitor its development throughout medical training. Consequently, they can be employed to assess clinical reasoning skill in individual students and to evaluate the success of undergraduate medical schools in providing effective tuition in clinical reasoning.