Abstract
BackgroundEffective clinical reasoning is a core competency of health professionals that is necessary to assure patients’ safety. Unfortunately, adoption of longitudinal clinical reasoning curricula is still infrequent. This study explores the barriers that hinder the explicit teaching of clinical reasoning from a new international perspective.MethodsThe context of this study was a European project whose aim is to develop a longitudinal clinical reasoning curriculum. We collected data in semi-structured interviews with responders from several European countries who represent various health professions and have different backgrounds, roles and experience. We performed a qualitative content analysis of the gathered data and constructed a coding frame using a combined deductive/inductive approach. The identified themes were validated by parallel coding and in group discussions among project members.ResultsA total of 29 respondents from five European countries participated in the interviews; the majority of them represent medicine and nursing sciences. We grouped the identified barriers into eight general themes: Time, Culture, Motivation, Clinical Reasoning as a Concept, Teaching, Assessment, Infrastructure and Others. Subthemes included issues with discussing errors and providing feedback, awareness of clinical reasoning teaching methods, and tensions between the groups of professionals involved.ConclusionsThis study provides an in-depth analysis of the barriers that hinder the teaching of explicit clinical reasoning. The opinions are presented from the perspective of several European higher education institutions. The identified barriers are complex and should be treated holistically due to the many interconnections between the identified barriers. Progress in implementation is hampered by the presence of reciprocal causal chains that aggravate this situation. Further research could investigate the perceptual differences between health professions regarding the barriers to clinical reasoning. The collected insights on the complexity and diversity of these barriers will help when rolling out a long-term agenda for overcoming the factors that inhibit the implementation of clinical reasoning curricula.
Highlights
Effective clinical reasoning is a core competency of health professionals that is necessary to assure patients’ safety
This study provides an in-depth analysis of the barriers that hinder the teaching of explicit clinical reasoning
Further research could investigate the perceptual differences between health professions regarding the barriers to clinical reasoning
Summary
Effective clinical reasoning is a core competency of health professionals that is necessary to assure patients’ safety. Clinical reasoning (CR) is a complex process that uses cognition and discipline-specific knowledge to gather and analyze patient information, evaluate its significance, and weigh alternative actions [3] It includes tasks such as data gathering and interpretation, synthesizing information, generating hypotheses and diagnoses, developing management plans, and avoiding cognitive errors [4]. The literature suggests that explicit teaching of clinical reasoning must start from the very beginning of medical school [6]. Studies suggest it should be taught longitudinally (i.e. developed and assessed at several points throughout the curriculum) [5, 7]. Survey studies reveal limited faculty development opportunities in clinical reasoning teaching despite the clear demand [8, 9]
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