Abstract
This article was migrated. The article was marked as recommended. Introduction: This study explores tutors' experience of teaching diagnostic reasoning (DR) - a key component of clinical reasoning - to build understanding into the use of explicit strategies in facilitating development of DR skills in preclinical medical students. Methods: A qualitative, interpretive study was undertaken with 14 preclinical problem-based learning tutors who participated in semi-structured interviews. A thematic analysis was conducted to identify key factors that influence students' learning of diagnostic reasoning. Results: Tutor dispositions towards facilitating learning of DR were variable in this study. Explicit strategies to teach DR were thought to exert positive influences on the development of DR skills, through improving student knowledge and reducing potential error. The advantages of using explicit strategies to teach DR outweighed the perceived difficulties identified in this context. Explicit strategies may need modification for preclinical students and the focus should be on building knowledge of classic presentations and developing metacognitive awareness. Conclusion: The use of explicit educational strategies will contribute to facilitating preclinical student learning of DR skills. Tutor professional development is a key component in the successful implementation of these strategies.
Highlights
This study explores tutors’ experience of teaching diagnostic reasoning (DR) – a key component of clinical reasoning – to build understanding into the use of explicit strategies in facilitating development of DR skills in preclinical medical students
This study has focused on DR, as this is an early step in the reasoning process relevant in the preclinical setting
The findings of this study suggest a need for tutors to be equipped with explicit teaching strategies to help preclinical students develop DR skills
Summary
This study explores tutors’ experience of teaching diagnostic reasoning (DR) – a key component of clinical reasoning – to build understanding into the use of explicit strategies in facilitating development of DR skills in preclinical medical students. Poor CR skills are responsible for a significant percentage of medical error (Croskerry, 2009), diagnostic error (Nendaz and Perrier, 2012). Clinical reasoning (CR) encompasses a variety of cognitive processes involved in a clinical encounter, including data gathering and analysis, hypothesis generation, retrieval of stored knowledge, and diagnostic and management decision-making. Diagnostic reasoning (DR) refers to the component of CR relating to making a diagnosis. This study has focused on DR (rather than CR generally), as this is an early step in the reasoning process relevant in the preclinical setting. Whilst some of the literature cited refers to CR generally, it has been used because of its relevance to the DR component of CR
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