Wednesday, July 1, 2015

A developmental study to assess undergraduate medical students' knowledge of clinical reasoning processes

Karen Forbes, MD, MEd
University of Alberta

Background: Clinical reasoning is neither easily nor explicitly taught, in general, in undergraduate medical education, but remains a fundamental physician competency. During their undergraduate medical education studies, students often focus on learning knowledge, and struggle with developing clinical reasoning skills.

Aims: To gain an understanding of what students know and understand about clinical reasoning at different points in their undergraduate medical education.
Methods: A mixed-methods study was undertaken. A survey of two hundred and sixty-nine students across the four years of the MD program at the University of Alberta completed surveys regarding their knowledge, beliefs, behaviors and learning of clinical reasoning. Thirteen students subsequently participated in in-depth interviews on the same content areas, and also completed a think-aloud exercise. Curriculum mapping of what is currently taught regarding clinical reasoning is underway.
Results: A developmental model has been created to represent some of the changes that are seen as students progress from the pre-clinical to clinical years of their undergraduate medical education. Learning of clinical reasoning, mapped to current curricular content and methods is still underway.
Conclusions: Deliberate teaching about clinical reasoning is likely to be of value to students to help them understand reasoning processes, and recognize the place, strengths and limitations of different types of reasoning. Use of reflection and metacognition as educational tools are likely to be valuable means of teaching about clinical reasoning processes. This study provides data that will serve to complete a needs assessment required for the development of a comprehensive longitudinal curriculum in clinical reasoning at the University of Alberta.