Clinical Reasoning Needs to Be Explicitly Addressed in Health Professions Curricula: Recommendations from a European Consortium.

Ioannis Parodis,Andrzej A Kononowicz,Lina Andersson,Magdalena Szopa,Jure Knez,Marie Lidskog,Inga Hege,Tadej Petreski,Samuel Edelbring,Steven J Durning

doi:10.3390/ijerph182111202

Abstract

Clinical reasoning entails the application of knowledge and skills to collect and integrate information, typically with the goal of arriving at a diagnosis and management plan based on the patient’s unique circumstances and preferences. Evidence-informed, structured, and explicit teaching and assessment of clinical reasoning in educational programs of medical and other health professions remain unmet needs. We herein summarize recommendations for clinical reasoning learning objectives (LOs), as derived from a consensus approach among European and US researchers and health professions educators. A four-step consensus approach was followed: (1) identification of a convenience sample of the most relevant and applied national LO catalogues for health professions educational programs (N = 9) from European and US countries, (2) extraction of LOs related to clinical reasoning and translation into English, (3) mapping of LOs into predefined categories developed within the Erasmus+ Developing, implementing, and disseminating an adaptive clinical reasoning curriculum for healthcare students and educators (DID-ACT) consortium, and (4) synthesis of analysis findings into recommendations for how LOs related to clinical reasoning could be presented and incorporated in LO catalogues, upon consensus. Three distinct recommendations were formulated: (1) make clinical reasoning explicit, (2) emphasize interprofessional and collaboration aspects of clinical reasoning, and (3) include aspects of teaching and assessment of clinical reasoning. In addition, the consortium understood that implementation of bilingual catalogues with English as a common language might contribute to lower heterogeneity regarding amount, structure, and level of granularity of clinical reasoning LOs across countries. These recommendations will hopefully motivate and guide initiatives towards the implementation of LOs related to clinical reasoning in existing and future LO catalogues.

Highlights

Curriculum development for health professions education (HPE) is commonly guided by overarching collections of learning objectives (LOs)
Clinical reasoning is rarely explicitly addressed in HPE curricular policy documents
Consortium, we recommend that clinical reasoning should be made explicit in national LO catalogues, including aspects of its teaching and assessment, and that collaboration aspects within and across professions, as well as with the patients, should be emphasized

Summary

Introduction

Curriculum development for health professions education (HPE) is commonly guided by overarching collections of learning objectives (LOs). These are often disconnected from explicit objectives for the core ability of clinical reasoning [1,2]. Due to its multifactorial nature and unconscious components, clinical reasoning is difficult to learn, and difficult to teach in a systematic manner. Overlooking clinical reasoning in formal education necessitates that training of this ability occurs in the form of informal activities in clinical practice. Structured and explicit evidence-informed teaching and assessment of clinical reasoning in educational programs of health professions constitute important needs [2,6]

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Conclusion