Centro de P&D UNA-SUS Amazônia/UEA (BRAZIL) THE USE OF IDEA AS A TOOL FOR THE CONSTRUCTION OF CLINICAL CASES RELATED TO HEALTH Hello, my name is Desirée Gomes and I will present a proposal for the construction of clinical cases in the health area. G.L.A. Trindade da Silva, D. Silva Nogueira, R. Pinto Zacarias Filho, D.E. Dantas Gomes, W.O. Magalhães dos Santos

ROAD MAP Introduction Objective of the study Methodology Results Conclusion The presentation will follow this road map: Introduction, Objective of the study, Methodology, Results and Conclusion.

INTRODUCTION Health professionals Making decisions Experiences In the clinical practice of health professionals is common making decisions based on acquired experiences.

INTRODUCTION Critical Thinking Clinical Reasoning and New ways to develop Due to the subjectivity of the problems, these professionals look for ways to develop critical thinking and clinical reasoning. In this process, it must be considerate the patient and professional's environment. Therefore, the university has an important role in the development of these skills, during the academic process.

CLINICAL REASONING The development of the clinical reasoning must be preceded by critical thought, where it enables individuals the act to judge the situation and to decide the next step. Health professionals Patients Teaching the academics this reasoning is essential for job market training The development of the clinical reasoning must be preceded by critical thought, where it enables individuals the act to judge the situation and to decide the next step. Similary, the clinical reasoning operates in making decisions, but in the context where the health professional and the patient are. Teaching the academics this reasoning is essential for job market training and exist different methods for develop this hability.

CLINICAL CASES A way to encourage critical reasoning is using clinical cases, common activity in the health area, promoting the integration of knowledge and practice between professionals. The construction of these cases are usually made neither following patterns nor chronological common guidelines. This show the significance of the support tool in the development of clinical cases, enabling better organization and understanding of it. A way to encourage critical reasoning is using clinical cases, common activity in the health area, promoting the integration of knowledge and practice between professionals. However, the construction of these cases are usually made neither following patterns nor chronological common guidelines, making it less intelligible, the students or health professional to choose the best method for build and organize it. This show the significance of the support tool in the development of clinical cases, enabling better organization and understanding of it.

OBJECTIVE OF THE STUDY The main objective of this paper is to show a model of clinical case structure to health area. In this perspective, this work aims to show a model of clinical case structure to health area.

Portuguese, English and Spanish Inclusion criteria Complete articles Published 2013-2018 Language Portuguese, English and Spanish Exclusion criteria Theses Dissertations Literature review METHODOLOGY This study was based on a review of the literature; Databases: Medical Literature Analysis and Retrieval System Online (Medline) along with PubMed and LILACS (Latin American and Caribbean Literature in Health Sciences); Descriptors: "Clinical Reasoning" AND "Problem Based Learning" AND "Critical Thinking“; This study was based on a review of the literature with the purpose of identifying and analyzing the relevant articles for of tools for the construction of clinical cases, as well as to promote the development of the logical reasoning of academics and health professionals. The research was carried out in the databases of the Medical Literature Analysis and Retrieval System Online (Medline) along with PubMed and LILACS (Latin American and Caribbean Literature in Health Sciences). In order to search the database, the following descriptors and their combinations with the Boolean operators were used: "Clinical Reasoning" AND "Problem Based Learning" AND "Critical Thinking". As selection criteria of articles were adopted: complete articles, published in the period between 2013 to 2018, that were in the vernacular Portuguese, English or Spanish and that dealt with the thematic of the revision. Theses, dissertations and literature reviews were excluded.

RESULTS 141 articles were found joining the databases. Figure 1. Flowchart for the selected articles included in the study. Excluded by title and summary: 120 LILACS Filter: period of 05 years Excluded by title and summary: 01 MEDLINE Included: 00 Included: 20 Total articles Included: 20 Articles excluded by duplicity in the bases: 01 Total articles included: 19 LILACS: 00 MEDLINE: 19 Potentially relevant articles: LILACS: 01; MEDLINE by means of PUBMED: 140. RESULTS 141 articles were found joining the databases. 120 articles did not meet the criteria of the research. A total of 19 articles were selected Figure 1 demonstrates the results of searching the databases and selecting the articles. A total of 141 articles were found joining the databases. After reading the titles and abstracts, 120 articles did not meet the criteria of the research. A total of 19 articles were selected for the complete reading, which fulfilled the criteria proposed by the research. In general, Figure 1 demonstrates the results of searching the databases and selecting the articles. By autors, 2019

CRITICAL AND CLINICAL THINKING CRITICAL THINKING CLINICAL REASONING MAKING DECISIONS IN EVIDENCE The review it was possible to perceive that critical and clinical thinking are inseparable and that the health professional or academic needs to understand the biological, psychological, social and spiritual aspects that surround the subject and to relate them to better resolution of a clinical case and formulation of accurate diagnoses. Reasoning of the pathophysiological processes that occur with the human being Integration of diagnostic data Safe diagnosis and grounded attitudes that result in resolution of the clinical case

Discussion tools of cases Script SYSTEMATIZATION Discussion tools of cases CLINICAL CASES The clinical cases make it possible to stimulate the critical and clinical thinking of the health professionals, either through real or hypothetical cases. The review pointed that many studies show the satisfaction and the sense of autonomy of the students who were stimulated to reason about the cases, but on the other hand they point out the lack of scripts that allow the systematic structuring of clinical cases. During the research was identified a model that allows to systematize the pertinent information to appear in the clinical cases, which will be discussed next.

Differential diagnosis Explanation of reasoning Alternative diagnosis IDEA TOOL I D E A Interpretive summary Differential diagnosis Explanation of reasoning Alternative diagnosis Where the main findings of the history, physical examination and complementary are allocated The IDEA tool can provide the health academic or professional with a reflection on the methodologies to be used for the diagnosis, allowing the incorporation of different resources, better structuring the clinical examination and stimulating the research of scientific evidence. Teaching in an individualized way is a very complex and tedious task, often accompanied by the restriction of time and the scarcity of human resources. This tool together with critical thinking and logical reasoning are able to improve teaching-learning, making tasks progressively more complete. The acronym IDEA is a tool that enables better organize the clinical reasoning and interpretation. The tool consists of four elements. Interpretive summary where the main findings of the history, physical examination and complementary are allocated. Differential diagnosis is understood as the main hypothesis of the case. Explanation of reasoning is the reason for choosing the diagnosis in the previous item and the information that supports it. Alternative diagnosis is the differential diagnosis. The sub-items that should be in this item are: Identification, Main Complaint, History of Current Illness, description of environment, contextualization of, a complete and comprehensible story in a succinct way addressing the essential elements for clinical reasoning. Is understood as the main hypothesis of the case Is the reason for choosing the diagnosis in the previous item and the information that supports it Is the differential diagnosis. A complete and comprehensible story in a succinct way addressing the essential elements for clinical reasoning

CONCLUSION The clinical reasoning skill is absolutely indispensable; The acronym IDEA becomes an essential tool for the construction of clinical cases; It is necessary to the clinical case construction model directed for health professionals and students, as well as further study focused for IDEA tool. Clinical skills are constantly required and, in this context, the clinical reasoning skill is absolutely indispensable, therefore, can be observed that use of IDEA tool for the construction of clinical cases to the health area provides scientific and logical contribution for the health professional or student organize the clinical elements of the patient in a multidimensional way when it comes to problem-based learning. From the results obtained in this review, it was possible to understand that the IDEA tool is an element important for the clinical case organization and for critical, clinical and diagnostic reasoning, that promotes intelligibility to the clinical case and directionality to the script. It was noticed that it is necessary to the clinical case construction model directed for health professionals and students, as well as further study focused for IDEA tool.

© Universidade do Estado do Amazonas THANKS www.unasusamazonia.com.br contato@unasusamazonia.com.br +55 92 3021-7717 +55 92 3028-5645 © Universidade do Estado do Amazonas