Predictors of clinical reasoning in neurological localisation: A study in internal medicine residents

Abstract

Introduction: Clinical reasoning is the cognitive process of weighing clinical information together with past experience to evaluate diagnostic and management dilemmas. There is a paucity of literature regarding predictors of clinical reasoning at the postgraduate level. We performed a retrospective study on internal medicine residents to determine the sociodemographic and experiential correlates of clinical reasoning in neurological localisation, measured using validated tests. Methods: We recruited 162 internal medicine residents undergoing a three-month attachment in neurology at the National Neuroscience Institute, Singapore, over a 2.5 year period. Clinical reasoning was assessed on the second month of their attachment via two validated tests of neurological localisation–Extended Matching Questions (EMQ) and Script Concordance Test (SCT). Data on gender, undergraduate medical education (local vs overseas graduates), graduate medical education, and amount of clinical experience were collected, and their association with EMQ and SCT scores evaluated via multivariate analysis. Results: Multivariate analysis indicated that local graduates scored higher than overseas graduates in the SCT (adjusted R2 = 0.101, f2 = 0.112). Being a local graduate and having more local experience positively predicted EMQ scores (adjusted R2 = 0.049, f2 = 0.112). Conclusion: Clinical reasoning in neurological localisation can be predicted via a two-factor model–undergraduate medical education and the amount of local experience. Context specificity likely underpins the process.