Acquisition Of Clinical Reasoning Skills Research Articles

Faculty Perceptions on Use of the Clinical Reasoning Assessment Tool to Support Learning in Physical Therapist Students: A Qualitative Study

Introduction. The clinical reasoning assessment tool (CRAT) is a patient-centered tool that was developed to assess students' progress in the development of clinical reasoning. The purpose of this qualitative study was to explore how academic and clinical faculty in a physical therapist curriculum use the CRAT to support the development and assessment of clinical reasoning in physical therapist student learners. Review of Literature. Clinical reasoning is a multifaceted process crucial to optimal patient care. The ability to teach, learn, and assess the development of clinical reasoning skills continues to be challenging due to the complexity of this necessary skill. Methods. A qualitative, thematic analysis approach was used to achieve the study objective. Qualitative data were collected from 3 focus group sessions, transcribed, and analyzed to identify, summarize, and interpret entry-level physical therapist educators' perceptions and experiences using the CRAT with physical therapist students. Results. Physical therapist educator participants (N = 13) reported using the CRAT as a guide for learning and assessment. Three qualitative themes were identified: 1) fostering understanding of clinical reasoning through organization and structure; 2) facilitating clinical reasoning through dialogue and self-reflection; and 3) assessment of clinical reasoning in the learner through benchmarking. Discussion and Conclusion. Study findings suggest that the structure and organization of the CRAT facilitated dialogue, student self-reflection, and assessment of clinical reasoning through benchmarking. The CRAT may support faculty in their work to further the learners' acquisition of clinical reasoning skills.

Effects of a Blood Transfusion Course Using a Blended Learning Approach on the Acquisition of Clinical Reasoning Skills among Nursing Students in Morocco

learning clinical reasoning skills in nursing education is a challenge for teachers and students. This study investigated the effects of a blended learning program on the acquisition of clinical reasoning skills via a blood transfusion course. The study employed a two group randomised controlled design with an experimental group (group 1, 16 students) and a control group (group 2, 16 students) recruited from a population of second-year nursing students at the Mohamed VI University of Health Sciences in Casablanca, Morocco, during the 2018–2019 academic year. The experimental group received blended instruction, while the control group received traditional classroom instruction over four sessions. One month after the experiment, a post-test was conducted with both groups using 'key-feature questions' that included four clinical situations and 30 questions. The mean scores of the two groups were compared to assess the degree of acquisition of clinical reasoning skills. The mean post-test score was significantly higher in the experimental group than the control group (the p-value of the Mann-Whitney Test is less than 0.05). Moreover, a statistically significant correlation was detected between students' clinical reasoning scores and their theoretical examination marks. These results suggest that blended learning is useful for enhancing the clinical reasoning skills of nursing students, at least in the short term. Thus, it seems appropriate to develop more blended courses and integrate this approach into nursing education programs.

Can clinical case discussions foster clinical reasoning skills in undergraduate medical education? A randomised controlled trial

ObjectiveFostering clinical reasoning is a mainstay of medical education. Based on the clinicopathological conferences, we propose a case-based peer teaching approach called clinical case discussions (CCDs) to promote the respective...

Advancing clinical reasoning in virtual patients - development and application of a conceptual framework.

Background: Clinical reasoning is a complex skill students have to acquire during their education. For educators it is difficult to explain their reasoning to students, because it is partly an automatic and unconscious process. Virtual Patients (VPs) are used to support the acquisition of clinical reasoning skills in healthcare education. However, until now it remains unclear which features or settings of VPs optimally foster clinical reasoning. Therefore, our aims were to identify key concepts of the clinical reasoning process in a qualitative approach and draw conclusions on how each concept can be enhanced to advance the learning of clinical reasoning with virtual patients. Methods: We chose a grounded theory approach to identify key categories and concepts of learning clinical reasoning and develop a framework. Throughout this process, the emerging codes were discussed with a panel of interdisciplinary experts. In a second step we applied the framework to virtual patients. Results: Based on the data we identified the core category as the "multifactorial nature of learning clinical reasoning". This category is reflected in the following five main categories: Psychological Theories, Patient-centeredness, Context, Learner-centeredness, and Teaching/Assessment. Each category encompasses between four and six related concepts. Conclusions: With our approach we were able to elaborate how key categories and concepts of clinical reasoning can be applied to virtual patients. This includes aspects such as allowing learners to access a large number of VPs with adaptable levels of complexity and feedback or emphasizing dual processing, errors, and uncertainty.

Virtual patients in the acquisition of clinical reasoning skills: does presentation mode matter? A quasi-randomized controlled trial

BackgroundThe objective of this study is to compare two different instructional methods in the curricular use of computerized virtual patients in undergraduate medical education. We aim to investigate whether using many short and focused cases – the key feature principle – is more effective for the learning of clinical reasoning skills than using few long and systematic cases.MethodsWe conducted a quasi-randomized, non-blinded, controlled parallel-group intervention trial in a large medical school in Southwestern Germany. During two seminar sessions, fourth- and fifth-year medical students (n = 56) worked on the differential diagnosis of the acute abdomen. The educational tool – virtual patients – was the same, but the instructional method differed: In one trial arm, students worked on multiple short cases, with the instruction being focused only on important elements (“key feature arm”, n = 30). In the other trial arm, students worked on few long cases, with the instruction being comprehensive and systematic (“systematic arm”, n = 26). The overall training time was the same in both arms. The students’ clinical reasoning capacity was measured by a specifically developed instrument, a script concordance test. Their motivation and the perceived effectiveness of the instruction were assessed using a structured evaluation questionnaire.ResultsUpon completion of the script concordance test with a reference score of 80 points and a standard deviation of 5 for experts, students in the key feature arm attained a mean of 57.4 points (95% confidence interval: 50.9–63.9), and in the systematic arm, 62.7 points (57.2–68.2), with Cohen’s d at 0.337. The difference is statistically non-significant (p = 0.214). In the evaluation survey, students in the key feature arm indicated that they experienced more time pressure and perceived the material as more difficult.ConclusionsIn this study powered for a medium effect, we could not provide empirical evidence for the hypothesis that a key feature-based instruction on multiple short cases is superior to a systematic instruction on few long cases in the curricular implementation of virtual patients. The results of the evaluation survey suggest that learners should be given enough time to work through case examples, and that caution should be taken to prevent cognitive overload.

Respective value of the traditional clinical rotation and high fidelity simulation on the acquisition of clinical reasoning skills in medical students – A Randomized Controlled Trial.

This article was migrated. The article was marked as recommended. OBJECTIVE To assess the respective value of Traditional clinical rotation and High Fidelity Simulation (HFS) on the acquisition of clinical reasoning (CR) skills in Medical Students.METHODSA randomized controlled trial was conducted. Forty medical students were exposed to a full day of HFS, either during their Paediatric Term (PT) (Experimental group = PT+, HFS+) or, after completion of their PT (Control group = PT+, HFS-). CR skills were assessed by a Script Concordance Test (SCT) prior to group allocation and at the completion of PT.RESULTS39 out of 40 students completed both SCT. Scores before (mean/SD 57.4/6.7) and after (mean/SD 61.1/7.0) the PT were significantly improved (mean increase [95% confidence interval (CI)]: 3.6 [2.0-5.2]; p<0.0001; n=39). There was no added improvement from involvement in a full day of HFS in SCT scores between the experimental and the control groups (mean increase [95% CI]: 3.2 [0.5-5.9], n=18 versus 4.0 [1.9-6.1], n=21, respectively; p=0.61).CONCLUSIONExposure to PT significantly improves the medical students' CR acquisition with no further enhancement by exposure to HFS. Thus potential improvements in students' knowledge and skills due to exposure to HFS may not affect CR skills, and thus may not be assessable by SCT.

Teaching and Assessing Clinical Reasoning Skills.

Clinical reasoning is a core competency expected to be acquired by all clinicians. It is the ability to integrate and apply different types of knowledge, weigh evidence critically and reflect upon the process used to arrive at a diagnosis. Problems with clinical reasoning often occur because of inadequate knowledge, flaws in data gathering and improper approach to information processing. Some of the educational strategies which can be used to encourage acquisition of clinical reasoning skills are: exposure to a wide variety of clinical cases, activation of previous knowledge, development of illness scripts, sharing expert strategies to arrive at a diagnosis, forcing students to prioritize differential diagnoses; and encouraging reflection, metacognition, deliberate practice and availability of formative feedback. Assessment of clinical reasoning abilities should be done throughout the training course in diverse settings. Use of scenario based multiple choice questions, key feature test and script concordance test are some ways of theoretically assessing clinical reasoning ability. In the clinical setting, these skills can be tested in most forms of workplace based assessment. We recommend that clinical reasoning must be taught at all levels of medical training as it improves clinician performance and reduces cognitive errors.

Tracking Development of Clinical Reasoning Ability Across Five Medical Schools Using a Progress Test

Little is known about the acquisition of clinical reasoning skills in medical school, the development of clinical reasoning over the medical curriculum as a whole, and the impact of various curricular methodologies on these skills. This study investigated (1) whether there are differences in clinical reasoning skills between learners at different years of medical school, and (2) whether there are differences in performance between students at schools with various curricular methodologies. Students (n = 2,394) who had completed zero to three years of medical school at five U.S. medical schools participated in a cross-sectional study in 2008. Students took the same diagnostic pattern recognition (DPR) and clinical data interpretation (CDI) tests. Percent correct scores were used to determine performance differences. Data from all schools and students at all levels were aggregated for further analysis. Student performance increased substantially as a result of each year of training. Gains in DPR and CDI performance during the third year of medical school were not as great as in previous years across the five schools. CDI performance and performance gains were lower than DPR performance and gains. Performance gains attributable to training at each of the participating medical schools were more similar than different. Years of training accounted for most of the variation in DPR and CDI performance. As a rule, students at higher training levels performed better on both tests, though the expected larger gains during the third year of medical school did not materialize.

Web-based collaborative training of clinical reasoning: A randomized trial

Background: Clinical reasoning skills are essential for medical practice. Problem-based collaborative learning via the internet might prove useful in imparting these skills.Aim: This randomized study assessed whether web-based learning (WBL) is superior to face-to-face problem-based learning (PBL) in the setting of a 6-week cardio-respiratory course.Methods: During winter term 2007/08, all 148 fourth-year medical students enrolled in the 6-week course consented to be randomized in small groups to diagnose a patient complaining of dyspnoea either using a virtual collaborative online module or a traditional PBL session. Clinical reasoning skills were assessed by means of a key feature examination at the end of the course.Results: No significant difference between the mean scores of both study groups was detected (p = 0.843). In virtual learning groups, costs for diagnostic tests were significantly correlated to the number of contributions to online group discussions (r = 0.881; p = 0.002). Evaluation data favored traditional PBL sessions over virtual collaborative learning.Conclusion: While virtual collaborative learning was as effective as traditional PBL regarding the acquisition of clinical reasoning skills, it was less well accepted than traditional PBL. Future research needs to determine the ideal format and time-point for computer-assisted learning in medical education.

The development of reasoning skills and expertise in primary care

WHAT IS ALREADY KNOWN IN THIS AREA• The acquisition of clinical reasoning skills from novice to advanced student has been described and compared with experienced clinicians Research from the field of cognitive psychology suggests that development of such skills depends upon organizing packages of information into coherent structures which are quickly accessible from memory. These are called 'instance scripts?. Various strategies are employed in reasoning, starting with step-by-step analysis by novices, moving towards categorisation processes in-advanced practitioners (e.g. pattern recognition).WHAT THIS WORK ADDS• This work suggests a reference framework for reasoning skills and expertise development from novice to experienced practitioner within primary care. It extends ideas from existing Studies using medical students into postgraduate professional development, encompassing various transitions from newly qualified doctor to training registrar, and from new principal towards the experienced practitioner.• Within these transitory stages, reasoning strategies are highlighted, including potential problem areas and appropriate educational implications. The role of follow up mechanisms for GP registrars is suggested to enable validation of illness vectors in the natural history of disease and recovery. Extension of training schemes to provide for expertise development in primary care is proposed as the logical context where such skills can be improved.SUGGESTIONS FOR FUTURE RESEARCH• Current research in medical education in the UK appears to be heavily concentrated upon skills and competency assessment. These are more easily measured than cognitive skills. However, the impact of early clinical contact in UK medical schools upon cognitive skills could be compared with other countries where clinical contact is still delayed. Early patient contact may shift acquisition of some cognitive skills back in the proposed framework.• In addition to this, the impact of the foundation programme upon doctors subsequently entering primary care will provide the biggest stimulus for research, assuming that cognitive attributes, such as decision-making skills, are assessed alongside practical competencies.

Online clinical reasoning assessment with the Script Concordance test: a feasibility study

BackgroundThe script concordance (SC) test is an assessment tool that measures capacity to solve ill-defined problems, that is, reasoning in context of uncertainty. This tool has been used up to now mainly in medicine. The purpose of this pilot study is to assess the feasibility of the test delivered on the Web to French urologists.MethodsThe principle of SC test construction and the development of the Web site are described. A secure Web site was created with two sequential modules: (a) The first one for the reference panel (n = 26) with two sub-tasks: to validate the content of the test and to elaborate the scoring system; (b) The second for candidates with different levels of experience in Urology: Board certified urologists, residents, medical students (5 or 6th year). Minimum expected number of participants is 150 for urologists, 100 for residents and 50 for medical students. Each candidate is provided with an individual access code to this Web site. He/she may complete the Script Concordance test several times during his/her curriculum.ResultsThe Web site has been operational since April 2004. The reference panel validated the test in June of the same year during the annual seminar of the French Society of Urology. The Web site is available for the candidates since September 2004. In six months, 80% of the target figure for the urologists, 68% of the target figure for the residents and 20% of the target figure for the student passed the test online. During these six months, no technical problem was encountered.ConclusionThe feasibility of the web-based SC test is successful as two-thirds of the expected number of participants was included within six months. Psychometric properties (validity, reliability) of the test will be evaluated on a large scale (N = 300). If positive, educational impact of this assessment tool will be useful to help urologists during their curriculum for the acquisition of clinical reasoning skills, which is crucial for professional competence.