Clinical Reasoning Competence Research Articles

Teaching Clinical Reasoning to Veterinary Medical Learners with a Case Example

Clinical reasoning is an essential competence of veterinary graduands. It is a complex competence with cognitive, metacognitive, social, and situational activities. The literature on clinical reasoning in veterinary medical education is relatively scarce or focused on theoretical rather than practical applications. In this review, we address the practicality of teaching clinical reasoning to veterinary learners utilizing a practical example of a cow with allergic rhinitis. Learners should be guided through all the domains of clinical reasoning, including concepts, data collection and analysis, take action, and reflection on an encounter. Each of these domains needs to be clearly but concisely explained and practiced repeatedly by learners throughout the veterinary curricula. The teaching of clinical reasoning should start as early in the curriculum as possible, preferably in the pre-clinical years, with a gradual scaffolding and building of complexity before work-based learning begins, with an increase in demanding for advanced clinical reasoning competence. The teaching of clinical reasoning is best performed in specialized sessions and continued as a horizontally and vertically integrated activity.

Comparing the effects of patient safety education using design thinking and case based learning on nursing students’ competence and professional socialization: A quasi-experimental design

BackgroundPatient safety issues should be constantly monitored and sensitively recognized. In nursing education, it is necessary to find effective teaching methods to increase students' competencies in patient safety. ObjectivesThis study aimed to compare the effectiveness of a new method, design thinking (DT), and a traditional method, case-based learning (CBL), in patient safety education. DesignThis study used a quasi-experimental, pre-post control group design. SettingsA 30-h training tutorial was developed for intervention groups, DT and CBL, while the control group received no treatment. ParticipantsIn this study were junior nursing students receiving baccalaureate nursing education with experiences of at least 480-h clinical practice. A total of 53 students (21 in the DT group, 19 in the CBL group, and 13 in the control group) were recruited. MethodsClinical reasoning competency, patient safety competency, and professional socialization were measured immediately after the end of the educational program using DT and CBL, 4 weeks later, and 8 weeks later. Effects of DT and CBL were analyzed using a generalized estimating equation. ResultsBoth DT and CBL were effective in clinical reasoning competency (χ2 = 15.432, p = 0.017) and knowledge domain of patient safety competency (χ2 = 42.824, p < 0.001), showing no significant difference between the two. CBL was more effective in professional socialization than DT. ConclusionsDT was as effective as CBL in clinical reasoning competency and knowledge domain of patient safety competency. In the healthcare field, where improving the patient experience is becoming increasingly important, DT is worth applying as an educational method to train nursing students who can take a creative and human-centered problem-solving approach. It is expected that educational curricula utilizing DT will be developed not only in the field of patient safety but also in various patient care areas.

Comparative study of clinical reasoning competence and self-directed learning competence in nurses across varied years of experience.

To compare and analyse the differences in the clinical reasoning competence of nurses with different working years and their relationship with self-directed learning competence. A cross-sectional survey design (online investigation) was used. A total of 376 nurses were recruited from four independent hospitals in China. Online questionnaires collected data on nurses' demographic characteristics and assessed their clinical reasoning and self-directed learning competence. Pearson correlation analysis, t-test, analysis of variance (ANOVA) and multivariate regression analysis were used. Clinical reasoning competence scores of nurses with working years >10 years were higher than those of other nurses. Self-directed learning competence scores of nurses with working years of <1 year and (from ≥1 year to <3 years) were lower than those of nurses with working years of 6-10 years and >10 years. Self-directed learning competence scores of nurses with working years of 3-5 years were lower than those of nurses with working years of >10 years. There was a positive correlation between clinical reasoning competence, self-directed learning competence and each dimension among nurses of different working years. There are differences in the influence of different dimensions of self-directed learning competence on clinical reasoning competence among different working years. There were differences in clinical reasoning and self-directed learning competence among nurses with different working years. Self-directed learning competence is a positive predictor of nurses' clinical reasoning competence, which applied to nurses with all working years; however, the specific effect of self-directed learning competence on clinical reasoning competence differed among nurses with different working years. Nursing managers should pay attention to the development characteristics of clinical reasoning competence and self-directed learning competence of nurses with different working years and determine effective intervention strategies according to specific influencing factors.

간호대학생의 비판적 사고성향과 공감능력이 임상추론역량에 미치는 영향

Objectives This study is to assess the level of clinical reasoning skills of nursing students who are in the initial stages of learning clinical reasoning abilities, and to analyze the impact on these skills using quantitative and qual-itative research methods.&#x0D; Methods A mixed methods research approach was utilized. Quantitative data were collected using self-administered questionnaires from 163 nursing college students in Kimhae City. Qualitative data were collected through focus group interviews with 12 participants. The data were analyzed using a convergent design model.&#x0D; Results The quantitative analysis revealed that grades (β=.215, p=.003), major satisfaction (β=.163, p=.021), and critical thinking disposition (β=.593, p=&lt;.001) significantly influenced clinical reasoning competency, explaining 47.0% of the variance (F=18.826, p=&lt;.001, Adj R2=.470). The qualitative analysis indicated that students faced dif-ficulties due to lack of nursing knowledge and inadequate understanding of patient situations.&#x0D; Conclusions Educational programs aimed at enhancing clinical reasoning competency should include various methods such as presenting scenarios related to patient situations and teaching students how to search for rele-vant information, to facilitate students' understanding.

Using "board games" to improve the effectiveness of extracorporeal membrane oxygenation care for nurses in intensive care unit

AimThe purpose of this study was to evaluate the effectiveness of ECMO care board games facilitated teaching approach (ECMO care board games) in enhancing ECMO care knowledge, clinical reasoning and learning engagement among intensive care unit (ICU) nurses. BackgroundECMO is a highly complex, relatively low-incidence, high-risk clinical life support device system used in the intensive care unit (ICU). Its usage has increased nearly tenfold over the past 30 years. Traditionally, ECMO education has been delivered through classroom teaching, which has demonstrated limited effectiveness in promoting nurses’ learning engagement, clinical reasoning competency and confidence. The literature suggests that well-designed board games can enhance learning engagement, stimulate higher-level thinking and improve the effectiveness and confidence of nurses' learning. DesignA quasi-experimental study two-group repeated measure design. MethodsA purposive sample of 73 ICU nurses from two campuses of one medical center was recruited (37 in the experimental group and 36 in the control group). The experimental group received ECMO care training through ECMO care board games facilitated teaching approach, whereas the control group completed the training through a traditional teaching approach. Instruments used for data collection include a demographic information sheet, ECMO Care Knowledge Scale, Clinical Reasoning Scale (Huang et al., 2023) and Learning Engagement Scale (Ciou , 2020). Both groups completed a pre-test before the training, a post-test one week after the training and a second post-test three weeks after the training. ResultsPrior to the intervention, there were no significant differences between the two groups in ECMO care knowledge and learning engagement. However, there was a significant difference in clinical reasoning. One week after the intervention, the experimental group demonstrated significantly higher scores in ECMO care knowledge, clinical reasoning and learning engagement than the control group (p <0.01). Three weeks after the intervention, the experimental group showed significantly higher scores in ECMO care knowledge, clinical reasoning and learning engagement (p <0.001). ConclusionsThe content for ECMO care is complex and difficult. Board games can enhance ECMO care knowledge, clinical reasoning and learning engagement. This teaching strategy may be applied to learning challenging subjects in the future to improve learning effectiveness. The clinical reasoning framework is conducive to guiding nurses' learning. In future continuing education, board games designed based on the clinical reasoning framework and tailored to the focus of in-service education can effectively enhance nurses' learning effectiveness.

시뮬레이션 기반 결핵환자 간호교육이 간호대학생의 지식, 임상추론역량, 임상수행능력, 교육만족도에 미치는 효과

시뮬레이션 기반 결핵환자 간호교육이 간호대학생의 지식, 임상추론역량, 임상수행능력, 교육만족도에 미치는 효과

임상사례기반 SBAR를 적용한 급성악화환자간호 시뮬레이션 교육이 의사소통명확성, 의사소통자신감, 임상추론역량에 미치는 효과

Objectives The purposes of this study was to identify the effect of nursing simulation education for acute deteriorating patients using clinical case-based SBAR on communication clarity, communication confidence, and clinical reasoning competency.&#x0D; Methods This quasi-experimental study used a one group pre-post design. The participants were 41 nursing students. A survey to collect data was conducted twice, before and after education. Data were analyzed using the SPSS 23.0 program with descriptive statistics and paired t-test.&#x0D; Results Communication clarity (t=7.906, p&lt;.001), communication confidence (t=24.623, p&lt;.001) and clinical reasoning competency (t=6.427, p&lt;.001) were significantly improved after education compared to before.&#x0D; Conclusions This study is the first study to evaluate the effectiveness of nursing simulation education for acute deteriorating patients conducted in Korea. The results of this study can be used as basic data to develop a nursing education curriculum for patients with deterioration in Korea in the future. In addition, based on the results of this study, if nursing students' competency in nursing patients with acute deterioration is improved by expanding nursing simulation education by applying various contents and teaching methods, it will ultimately contribute to improving the prognosis of patients with acute deterioration.

"Learning a Way of Thinking"-World Café on Clinical Reasoning in Nursing and Midwifery Education and Practice across Five European Union Countries.

Clinical reasoning is a key attribute of nursing and midwifery professionals. As a part of the Erasmus plus project, we designed a study with the aim of exploring the understanding of clinical reasoning as a concept, experiences of teaching clinical reasoning and practices related to using clinical reasoning in nursing and midwifery. A qualitative study was carried out using the World Café method, involving 44 participants from five European countries. The participants represented diverse professional backgrounds, including nurses, midwives and lecturers. Our analytical approach was based on a thematic analysis. We categorized the data into three main categories, namely, "Spiral of thinking", "The learning and teaching of a way of thinking" and "Clinical reasoning in real life", all under an overarching theme, "Learning a way of thinking". This study highlighted areas of learning and teaching which can be improved in current nursing and midwifery education. Furthermore, it identified barriers, facilitators and practices from five European countries which can be used in the further development of nursing and midwifery curricula and courses with the aim of enhancing clinical reasoning competence and ultimately improving patient care.

The association between nursing students’ perceptions of their clinical reasoning ability and their background of clinical experience: A cross-sectional correlation study

Background and objective: Nursing students tend to show poor clinical reasoning skills and incompetence in clinical performance. This study aimed to explore nursing students’ perceptions of their clinical reasoning ability in relation to their different background of academic program and clinical experience.Methods: A cross-sectional correlation study was conducted in a private tertiary professional training institute. Nursing students (n = 508) were surveyed with demographic details and a self-reported Nurse Clinical Reasoning Scale (NCRS) questionnaire about their perceptions of clinical reasoning in relation with their clinical experience.Results: Descriptive statistic, parametric analyses of variance, and Pearson’s correlation coefficients were used to determine the relationships between variables. The mean NCRS score was lower for paid student nurse externs (49.22 ± 9.2) than for participants who were not paid student nurse externs. The mean NCRS scores differed significantly between the different clinical placements that nursing students last experienced (F = 5.41, p ≤ .001), as well as between students of various academic programs (F = 11.88, p ≤ .001), with students of the sub-baccalaureate level nursing program showing the highest score (53.04 ± 10.48), followed by those of the accelerated baccalaureate level nursing program (52.93 ± 7.67) and those of the baccalaureate level nursing program (48.82 ± 10.11). The mean NCRS score showed a weakly positive, but significant, correlation with the attendance of pre-clinical training, r(506) = .12, p = .009. The free-text surveys provided rich information concerning nursing students’ preferences for future pre-clinical training.Conclusions: Different academic backgrounds and clinical experiences influence nursing students’ clinical reasoning competence. Strategies are needed to motivate earlier clinical preparedness and caring attitudes which are essential attributes of a nursing student before their exposure to real patients.

Effects of Handover Education Using the Outcome-Present State Test (OPT) Model and SBAR in Nursing Students: A Quasi-Experimental Design.

Since most of nursing students lack clinical reasoning competency, for effective handover education, it is necessary to include a strategy to improve the clinical reasoning competency in the practical training course of the nursing department. This study used a quasi-experimental research design using a non-equivalent control group pretestposttest design to verify the effectiveness of the practice education program using the OPT model and SBAR. The subjects were 73 third-year students participating in clinical practice or clinical alternative practice in Korea. The experimental group showed significantly better communication clarity (t=-12.262, P<.001), communication confidence (t=-12.486, P<.001), problem-solving processes (t=-13.100, P<.001), and team efficacy (t=-6.197, P<.001) compared to before the intervention. However, there was no significant difference between the pre- and post-intervention scores of the control group. In a situation where clinical practice is difficult for nursing students, the handover education program using the OPT model and SBAR can helps improve their communication clarity, communication confidence, problem-solving process, and team efficacy.

Using virtual reality in a blended learning course of clinical reasoning competency in primary care: a case study in Central Vietnam

Using virtual reality in a blended learning course of clinical reasoning competency in primary care: a case study in Central Vietnam

Development of the clinical reasoning competency scale for nurses

BackgroundClinical reasoning is emphasized as an important component of nursing education, since nurses’ lack of clinical reasoning leads to incorrect clinical decision-making. Therefore, a tool for measuring clinical reasoning competency needs to be developed.MethodsThis methodological study was conducted to develop the Clinical Reasoning Competency Scale (CRCS) and examine its psychometric properties. The attributes and preliminary items of the CRCS were developed based on a systematic literature review and in-depth interviews. The validity and reliability of the scale were evaluated among nurses.ResultsThe exploratory factor analysis was conducted for the construct validation. The total explained variance of the CRCS was 52.62%. The CRCS consists of 8 items for plan setting, 11 items for intervention strategy regulation, and 3 items for self-instruction. The Cronbach’s α of the CRCS was 0.92. Criterion validity was verified with the Nurse Clinical Reasoning Competence (NCRC). The correlation between the total NCRC and CRCS scores was 0.78, all of which were significant correlations.ConclusionThe CRCS is expected to provide raw scientific and empirical data for various intervention programs to develop and improve nurses’ clinical reasoning competency.

통합시뮬레이션 교육이 간호대학생의 간호지식, 임상수행능력 및 임상추론역량에 미치는 효과

Objectives This study aimed to identify the effect of Integrated simulation(virtual reality simulation with high-fidelity simulation) education on nursing students’ knowledge, clinical performance, and clinical reasoning competency. A single group pre-post quasi-experimental design was used. Methods Data were collected from November 2021 to December 2021. Nursing knowledge, clinical performance ability, and clinical reasoning competency scores were analyzed from the learning evaluation data of 67 students before and after the integrated simulation class. Data were analyzed by Wilcoxon signed rank test using IBM SPSS 23.0 since the normality test was not satisfied. Results The results indicated that the group that participated in the integrated simulation education program had significantly higher nursing knowledge (z=6.201, p&lt;.001), clinical performance (z=4.999, p&lt;.001) and clinical reasoning competency (z=6.616, p&lt;.001) compared to the pre-test. Conclusions The results of this study can be used as basic data for developing educational programs that can enhance existing simulation classes and improve nursing knowledge, clinical performance, and clinical reasoning capabilities.

Effects of a Nursing Simulation Learning Module on Clinical Reasoning Competence, Clinical Competence, Performance Confidence, and Anxiety in COVID-19 Patient-Care for Nursing Students

This study aimed to develop a nursing simulation learning module for coronavirus disease 2019 (COVID-19) patient-care and examine its effects on clinical reasoning competence, clinical competence, performance confidence, and anxiety in COVID-19 patient care for nursing students. A non-equivalent control group pre- and post-test design was employed. The study participants included 47 nursing students (23 in the experimental group and 24 in the control group) from G City. A simulation learning module for COVID-19 patient-care was developed based on the Jeffries simulation model. The module consisted of a briefing, simulation practice, and debriefing. The effects of the simulation module were measured using clinical reasoning competence, clinical competence, performance confidence, and anxiety in COVID-19 patient-care. Data were analyzed using χ²-test, Fisher's exact test, t-test, Wilcoxon signed-rank test, and Mann-Whitney U test. The levels of clinical reasoning competence, clinical competence, and performance confidence of the experimental group were significantly higher than that of the control group, and the level of anxiety was significantly low after simulation learning. The nursing simulation learning module for COVID-19 patient-care is more effective than the traditional method in terms of improving students' clinical reasoning competence, clinical competence, and performance confidence, and reducing their anxiety. The module is expected to be useful for educational and clinical environments as an effective teaching and learning strategy to empower nursing competency and contribute to nursing education and clinical changes.

A simulation-based OSCE with case presentation and remote rating - development of a prototype.

Simulation-based examination formats improve the possibility to assess medical students' competences during their performance. Additionally, videotaping of simulations allows for remote rating, providing advantages for raters, students, and exam organizers. We describe a simulation-based OSCE prototype with remote rating of students' competences, developed to replace a conventional OSCE at Hamburg Medical Faculty. The assessment consists of two phases: a consultation phase with four simulated patient encounters and a case presentation phase where four students present two cases each. All encounters from the consultation and the presentation phase are to be videotaped and remotely rated by clinical raters. Advanced medical students (year 4) are to be assessed regarding their clinical knowledge as well as physician-patient-communication, clinical reasoning competence, and patient management competence. We provide detailed schedules for the simulation-based OSCE procedure and a roster for organization. When piloting the assessment, we encountered two major obstacles with respect to legal obligations regarding examination time and videotaping which allowed us to provide tips on how to successfully implement this assessment prototype. Remote rating will, when successfully implemented, help students to concentrate on their consultation or presentation tasks, reduce raters' time constraints and also allow for randomized rating. Using established instruments for competence-rating rather than OSCE checklists provides an additional feature for this simulation-based OSCE prototype. Legal issues can be avoided by using the prototype for formative assessment but should be addressed in advance when it is planned to be used as summative assessment.

Percepção sobre o desenvolvimento da competência "raciocínio clínico" por graduandos de curso de medicina

Abstract: Introduction: The way by which physicians process clinical reasoning is a relevant topic in the discussions on medical education because, in medical activity, the ultimate goal is to obtain the correct diagnosis and conduct. The challenge is to highlight which factors influence this performance. Objective: The objective of this study is to understand how the development of the clinical reasoning competence occurs according to the medical students’ perception. Method: This research has a descriptive focus and employs a qualitative approach in the ordering of data, classification process, and final analysis of information from 36 semi-structured interviews with medical students, from July to September 2020, in Curitiba, Paraná, Brazil. Result: Thematic analysis was carried out, and the category ‘perception of the factors that influence its achievement’ emerged, with the ‘methodological and curricular structure’ subcategories perceived as the main influencing factors, through characteristics such as interdisciplinarity, early interaction with practical activities, stimulus to autonomy and teaching guidance. Participation in monitoring, academic leagues and extension projects were also considered, as well as the experience of the process of learning appropriation. Conclusion: The present study addresses the topic of clinical reasoning and brings as a contribution the analysis of the factors that influence its development, during undergraduate school, based on the students’ viewpoint. Its results bring benefits to medical education, as they expand the understanding of the process of developing the clinical reasoning competence.

Learning Model to Achieve Clinical Reasoning Competency Using Technology-Enhanced Learning in Neurology Clinical Rotation: An Exploratory Study

The COVID-19 pandemic has necessitated major adaptations in learning activities related to developing clinical reasoning competencies in neurology clerkship. The application of technology in this context is promising, but there are also several limitations. This study explores a learning model for achieving clinical reasoning competency using technology-enhanced learning in neurology clinical rotation. The study used a case-study design and was conducted at the Faculty of Medicine of YARSI University and its two teaching hospitals. Data were collected by document analysis, three focus group discussions with eight medical students and 20 postgraduate medical students, and five in-depth interviews with five neurologists. All the transcribed data were analysed with thematic analysis using the Steps for Coding and Theorization (SCAT) approach. Two themes were revealed—contributing factors and learning strategies—and six factors were found to influence the learning model: the quantity and quality of teacher interactions, students’ motivation and skills in learning and technology, the variety and number of patients in teaching hospitals, the quality and quantity of facilities and infrastructure for service and education at the teaching hospitals, the clinical rotation programme design, and learning adaptation during the pandemic. The following technology-enhanced learning strategies for developing clinical reasoning skills were identified: blended learning, online logbook, telemedicine, collaborative online learning between teaching hospitals, and learning videos. This learning model can be implemented in a limited resource setting. Importantly, the identified factors from the perspective of students, clinical teachers, and school of medicine/teaching hospital, as well as technical factors, should be considered for the implementation of this model.

Translation and Validation of the Persian Version of the Nurses Clinical Reasoning Scale (NCRS): A Psychometric Analysis

Purpose Nurses need strong clinical reasoning competency because they provide specialized and important care to patients. It is hence necessary to measure nurses’ clinical reasoning by using a valid and reliable tool. Objective This study aimed to translate and determine the psychometric test of Persian version of the nurses clinical reasoning scale. Methodology This study was a cross-sectional study. In the first step of this methodological study, the English version of Nurses Clinical Reasoning Scale (NCRS) was translated and back-translated. Then the content validity index (CVI) of the items was assessed based on expert views, and its face validity was examined by studying the views of the target group and experts. In the next step, 170 nurses working in hospitals affiliated with Tabriz University of Medical Sciences were asked to complete the instrument. Finally, the construct validity and reliability of this scale were measured using exploratory factor analysis (EFA) and internal consistency (Cronbach’s alpha), respectively. Results The findings showed that the CVI values of all the items were greater than .8. The wording of some items was changed based on the suggestions received regarding face validity, whereas the results of content and face validity did not necessitate the elimination of any of the items. The EFA results also suggested that the Persian version of the NCRS had a two-factor structure with the titles of nursing diagnosis and care knowledge. The Cronbach’s alpha for this scale was 0.91, which confirmed its internal consistency. Conclusion This instrument is valid and reliable enough to assess Iranian nurses’ clinical reasoning in the dimensions of nursing diagnosis and care knowledge. The research limitations and further recommendations will be discussed later in this paper.

Effects of Elaboration and Instructor Feedback on Retention of Clinical Reasoning Competence Among Undergraduate Medical Students

This randomized crossover trial examines whether elaboration on common errors in patient treatment, combined with individualized mailed feedback, improves medium-term retention of clinical reasoning competence.

Co-design: a guided reflective learning conversation model for simulation-based education

The critical care environment is stressful with complex clinical cases and high levels of workload [1]. Adequate exposure to various clinical experiences is essential to develop effective clinical reasoning skills [2]. Taking into consideration the risk of clinical practice mistakes and the importance of patient safety, simulation is an effective method to immerse learners in scenarios that mimic clinical situations with focused learning opportunities. Guided reflection through reflective learning conversations following simulation activities is recognized as an effective method to develop clinical reasoning skills [3]. We describe a co-design process to develop a simulation guided reflective learning conversation model to optimize the clinical reasoning skills for critical care nurses attending simulation-based activities. A co-design working group of 10 critical care nurses of varying levels of seniority, experience, nationality, and gender; two critical care doctors; three patient representatives; 2 researchers, and 5–6 critical care educators are working collaboratively to co-design the guided reflective learning conversation model, in which clinical reasoning can be optimized with consideration to a wide range of case complexity, subspecialty, and competence levels. The co-design working group is meeting online for 4–6 workshops of 4 hours. The co-design process is built on valid and reliable clinical reasoning and educational theoretical frameworks and models. The inputs to the process, exercises, and activities are taking place during the workshops and the outputs of the workshops are described to establish the co-design process. The final draft of the model will be validated and tested. The study sample will be grouped into experimental and control cohorts of critical care nurses who attend critical care simulation-based courses (N=300). Data will be collected through surveys, focus groups, and simulation-based objective assessment and observations. The study has received Institutional Review Board approval from the Hamad Medical Corporation Medical Research Centre (MRC-01-22-117) and the University of Hertfordshire (HSK/PGR/UH/04728). The first draft of the co-design model is presented in Simulation-Based Reflective Learning Conversation Model (SBRLCM) under development Clinical reasoning is multidimensional with difficulty to structure and evaluate during debriefing. Developing a guided reflective learning conversation model in which clinical reasoning skills are actively and effectively embedded, would therefore enable critical care nurses developing clinical reasoning skills to meet the special demands of critical care. 1. Vahedian-Azimi A, Hajiesmaeili M, Kangasniemi M, Fornés-Vives J, Hunsucker RL, Rahimibashar F, Pourhoseingholi MA, Farrokhvar L, Miller AC. Effects of stress on critical care nurses: a national cross-sectional study. Journal of intensive care medicine. 2019;34(4):311–22. 2. Kang H, Kang HY. The effects of simulation-based education on the clinical reasoning competence, clinical competence, and educational satisfaction. Journal of the Korea Academia-Industrial cooperation Society. 2020;21(8):107–14. 3. Decker S, Alinier G, Crawford SB, Gordon RM, Jenkins D, Wilson C. Healthcare Simulation Standards of Best Practice