Consensus statement on the content of clinical reasoning curricula in undergraduate medical education (original) (raw)
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Perspectives on Medical Education
Introduction Clinical reasoning is often not explicitly taught to novice medical students. Pre-clerkship clinical skills courses are an ideal venue to teach the clinical reasoning process. The aim of the study was to evaluate the impact of a preclinical clinical reasoning curriculum through an end-of-semester objective structured clinical examination. Methods This study was conducted through our longitudinal clinical skills course. Second year medical (M2) students who received the clinical reasoning curriculum in 2018 formed the study cohort. M2 students from the previous year, who did not have the clinical reasoning curriculum, formed the comparison cohort. Several modalities were used to teach clinical reasoning including whole case approach, serial cue approach, self-explanation of pathophysiological mechanisms and comparison of closely related diagnoses. The students interviewed a standardized patient and documented the history along with three likely diagnoses. Results Student...
Teaching Clinical Reasoning Among Undergraduate Medical Students: a Crossover Randomised Trial
Background: clinical reasoning is a mandatory competency in medical curriculum. Many techniques have been reported in order to teach it. The authors focused on 2 student-centered techniques, SNAPPS and collaborative critical reasoning learning (CCRL) technique, and compared their efficiency in order to improve the clinical reasoning competencies of third year medical education students.Methods: the authors performed a prospective randomised, controlled, non blinded crossover trial including year-3 undergraduate medical students. Judgement criteria consisted in the scores attributed to a structured summary performed by the students after each session. Besides, a satisfaction likert-scale questionnaire was fulfilled by the students. Statistical analysis was performed using SPSS software (version 20.0).Results: 72 students were included with a mean age of 21 years. The mean scores of CCRL reached 4.62 versus 4.99 for SNAPPS. No significant statistical difference was observed between th...
Clinical Reasoning and Improvement in the Quality of Medical Education
Shiraz E-Medical Journal, 2014
Background: "Clinical reasoning" is the key skill in medical practice, and well beyond mere medical knowledge. However, regarding the current medical school curriculums, little attention has been paid to develop such skills. It might be the reason why diagnostic errors are still the major causes of the patients' harm. Objectives: The purpose of this study was to investigate the effect of teaching clinical reasoning skills (problem-based training in small groups) on improvement of the clinical performance of medical interns. Materials and Methods: This quasi-experimental study was conducted from September 2012 to September 2013. All of the interns entering the Pediatrics Department of Hamadan Medical Faculty (4 three-month courses) were enrolled. Courses were assigned alternately as intervention and control. Interns in the control group had conventional training but for intervention group, a clinical reasoning workshop was held in addition to the conventional education. To assess both groups, the Clinical Reasoning Problem (CRP) test was used as the pretest and posttest. Data were analyzed with t test and paired t test. Results: Out of 62 participants, 30 (48%) were in the control group and 32 (52%) in the case group. Two groups were similar in baseline characteristics such as age and sex (P > 0.05). There was no significant difference between the scores of the two groups' pretests (P > 0.05). The mean pretest and posttest scores of the control group had no significant difference (P > 0.05), but comparison of the mean pretest and posttest scores of case group represented significant difference (P < 0.05). Conclusions: Clinical reasoning workshop will probably have a positive impact on upgrading clinical problem-solving skills.
Student experiences of learning clinical reasoning
The Clinical Teacher, 2019
Background: Students find learning clinical reasoning skills challenging. Viewing how students learn clinical reasoning skills from a sociocultural perspective, however, may allow helpful and unhelpful descriptions to be interpreted as experiences that promote or inhibit their participation in and opportunities to co-construct their clinical reasoning skills. Methods: This interview study was conducted with 25 Year-6 undergraduate medical students. Interview data were first analysed thematically, and then the
Teaching and assessing clinical reasoning skills
Indian Pediatrics, 2015
Clinical reasoning is a core competency expected to be acquired by all clinicians. It is the ability to integrate and apply different types of knowledge, weigh evidence critically and reflect upon the process used to arrive at a diagnosis. Problems with clinical reasoning often occur because of inadequate knowledge, flaws in data gathering and improper approach to information processing. Some of the educational strategies which can be used to encourage acquisition of clinical reasoning skills are: exposure to a wide variety of clinical cases, activation of previous knowledge, development of illness scripts, sharing expert strategies to arrive at a diagnosis, forcing students to prioritize differential diagnoses; and encouraging reflection, metacognition, deliberate practice and availability of formative feedback. Assessment of clinical reasoning abilities should be done throughout the training course in diverse settings. Use of scenario based multiple choice questions, key feature test and script concordance test are some ways of theoretically assessing clinical reasoning ability. In the clinical setting, these skills can be tested in most forms of workplace based assessment. We recommend that clinical reasoning must be taught at all levels of medical training as it improves clinician performance and reduces cognitive errors.
Developing a European longitudinal and interprofessional curriculum for clinical reasoning
Diagnosis
Clinical reasoning is a complex and crucial ability health professions students need to acquire during their education. Despite its importance, explicit clinical reasoning teaching is not yet implemented in most health professions educational programs. Therefore, we carried out an international and interprofessional project to plan and develop a clinical reasoning curriculum with a train-the-trainer course to support educators in teaching this curriculum to students. We developed a framework and curricular blueprint. Then we created 25 student and 7 train-the-trainer learning units and we piloted 11 of these learning units at our institutions. Learners and faculty reported high satisfaction and they also provided helpful suggestions for improvements. One of the main challenges we faced was the heterogeneous understanding of clinical reasoning within and across professions. However, we learned from each other while discussing these different views and perspectives on clinical reasoni...
Perspectives on medical education, 2020
Introduction Clinical reasoning is often not explicitly taught to novice medical students. Pre-clerkship clinical skills courses are an ideal venue to teach the clinical reasoning process. The aim of the study was to evaluate the impact of a preclinical clinical reasoning curriculum through an end-of-semester objective structured clinical examination. Methods This study was conducted through our longitudinal clinical skills course. Second year medical (M2) students who received the clinical reasoning curriculum in 2018 formed the study cohort. M2 students from the previous year, who did not have the clinical reasoning curriculum, formed the comparison cohort. Several modalities were used to teach clinical reasoning including whole case approach, serial cue approach, self-explanation of pathophysiological mechanisms and comparison of closely related diagnoses. The students interviewed a standardized patient and documented the history along with three likely diagnoses. Results Students in the study cohort achieved higher scores on differential diagnosis (1.98 vs. 1.64 in the comparison cohort, p < 0.001). There was no statistically significant difference in the frequency of relevant symptoms queried between the study and comparison cohorts (3.74 vs. 3.34, p > 0.05). Discussion Our study confirms that the introduction of clinical reasoning in a pre-clerkship clinical skills curriculum increases students' ability to select rele
A developmental assessment of clinical reasoning in preclinical medical education
Medical Education Online
Background: Clinical reasoning is an essential skill to be learned during medical education. A developmental framework for the assessment and measurement of this skill has not yet been described in the literature. Objective: The authors describe the creation and pilot implementation of a rubric designed to assess the development of clinical reasoning skills in pre-clinical medical education. Design: The multi-disciplinary course team used Backwards Design to develop course goals, objectives, and assessment for a new Clinical Reasoning Course. The team focused on behaviors that students were expected to demonstrate, identifying each as a 'desired result' element and aligning these with three levels of performance: emerging, acquiring, and mastering. Results: The first draft of the rubric was reviewed and piloted by faculty using sample student entries; this provided feedback on ease of use and appropriateness. After the first semester, the course team evaluated whether the rubric distinguished between different levels of student performance in each competency. A systematic approach based on descriptive analysis of mid-and end of semester assessments of student performance revealed that from mid-to end-of-semester, over half the students received higher competency scores at semester end. Conclusion: The assessment rubric allowed students in the early stages of clinical reasoning development to understand their trajectory and provided faculty a framework from which to give meaningful feedback. The multi-disciplinary background of the course team supported a systematic and robust course and assessment design process. The authors strongly encourage other colleges to support the use of collaborative and multi-disciplinary course teams.
Errors in clinical reasoning continue to account for significant morbidity and mortality, despite evidence-based guidelines and improved technology. Experts in clinical reasoning often use unconscious cognitive processes that they are not aware of unless they explain how they are thinking. Understanding the intuitive and analytical thinking processes provides a guide for instruction. How knowledge is stored is critical to expertise in clinical reasoning. Curricula should be designed so that trainees store knowledge in a way that is clinically relevant. Competence in clinical reasoning is acquired by supervised practice with effective feedback. Clinicians must recognise the common errors in clinical reasoning and how to avoid them. Trainees can learn clinical reasoning effectively in everyday practice if teachers provide guidance on the cognitive processes involved in making diagnostic decisions.