Learning Clinical Reasoning Research Articles

Exploring context and culture in clinical reasoning medical education: A qualitative exploratory study.

Clinical reasoning processes are complex and interwoven with culture and context. While these relationships have been explored to understand the outcomes of clinical reasoning, there has been little exploration of how to integrate these relationships when teaching and learning clinical reasoning. Using semi-structured interviews, this research explored the role of context and culture in clinical reasoning medical education. Participants were clinical teachers recruited from across Northern Ontario. The data were analysed independently by two reviewers using both thematic analysis and critical discourse analysis, and peer reviewed by a third researcher. The role of context and culture is inherent to the personal, professional and pedagogical aspects of clinical reasoning, especially when teaching about the complexities of Northern Ontario. The major themes that came through were: 1) teaching and learning clinical reasoning needs reflexivity, 2) developing clinical reasoning skills needs time and 3) clinical reasoning pedagogy should acknowledge and encompass practice variation and patient diversity. Teaching clinical reasoning in Northern Ontario involves being aware of the complexities that are inherent in interacting with patients and communities. Through personal, professional and pedagogical models, the students and teachers can address the complexities of cultural and contextual clinical reasoning.

Theory - Practice integration for Chinese Postgraduates in Pathophysiology: Innovative Teaching Strategies

Background: Pathophysiology plays a pivotal role in medical education by bridging basic sciences and clinical medicine. However, traditional teaching approaches in China often lack integration between theory and clinical practice, hampering postgraduates' understanding of disease mechanisms and diagnostic abilities. This study explores innovative strategies to effectively integrate theory and practice, enhancing Chinese medical postgraduates' learning.Methodology: A comprehensive literature review analyzed the current educational landscape and identified innovative teaching strategies aligning theoretical concepts with clinical applications. The implementation methods and potential to foster autonomous and innovative learning were examined.Results: Several student-centred strategies were identified, including problem-based learning (PBL), case-based learning (CBL), flipped classrooms, and integrated teaching models. These approaches emphasize active learning, critical thinking, and applying theoretical knowledge to clinical scenarios. Adopting these strategies can improve postgraduates' learning efficiency, problem-solving abilities, and clinical reasoning skills while promoting self-directed learning and innovative thinking.Conclusion: Integrating theory and practice through innovative teaching strategies is crucial to enhance the quality of pathophysiology postgraduate education in China. Educators should implement student-centred approaches like PBL, CBL, flipped classrooms, and integrated models to stimulate autonomous learning and cultivate innovation. Providing opportunities for active learning and clinical application can significantly improve postgraduates' learning outcomes and preparedness for future practice. Further research evaluating the long-term impact on postgraduate performance and patient care is warranted.

Assisting the Learning of Clinical Reasoning by Veterinary Medical Learners with a Case Example.

Effective clinical reasoning is essential for veterinary medical education, particularly in managing complex cases. This review explores strategies for learning clinical reasoning by veterinary medical learners, using a case example of mastitis to illustrate key concepts. Clinical reasoning encompasses cognitive, metacognitive, social, and situational activities, yet the literature on practical applications in veterinary education remains limited. The review discusses various stages of clinical reasoning, including data collection, problem representation, differential diagnosis, and management planning. It emphasizes the importance of integrating client-centered care and iterative evaluation into the clinical decision-making process. Key learning strategies include facilitation in using the domains of clinical reasoning-concepts, data collection, and analysis, taking action, and reflection on encounters. This review highlights best practices such as forward and backward reasoning, reflective practice, and the use of practical examples to enhance learners' diagnostic accuracy and patient outcomes. The insights provided aim to enhance the training of veterinary learners, ensuring they can navigate day 1 as well as complex cases with improved diagnostic accuracy and patient outcomes.

Debriefing to nurture clinical reasoning in nursing students: A design-based research study

BackgroundStudents' clinical reasoning can be stimulated by guiding them to use their experiences with patients to develop own illness scripts. Debriefing during hospital shifts invites students to put patient experiences into words, link them to previously acquired knowledge and make connections. ObjectivesTo develop, implement and evaluate a debriefing procedure for nursing internships based on illness script theory and generate corresponding design principles. DesignQualitative design-based research. SettingClinical education in dedicated educational hospital units. ParticipantsNurse educators, nursing students. MethodsFrom a collaboration between nurse educators and a researcher, a short, peer-debriefing procedure was designed, tested and enacted through four cycles of planning, action, evaluation and reflection. Students drew mind maps about patients. Nurse educators and students joined focus group discussions to evaluate outcomes and processes. Mind map and iterative thematic analysis were applied to these data. ResultsAn adjusted design and more extensive design principles resulted. Differences in mind maps were evident over time. Three themes in the process evaluation were established: trigger to reason; energy giving and taking; and form follows function. ConclusionsThis design-based investigation displays how nurse educators could design and implement a debriefing procedure to facilitate students' clinical reasoning skills and how students could learn from this. This method integrates research, innovation and collaboration. The design and enactment under real-life hospital conditions generated design principles for educators and researchers which may be useful for those seeking to improve teaching and learning clinical reasoning in practice. More clarification is needed about the path from design through enactment to real change in practice.

Impact of Teaching Methods on Clinical Reasoning in Forensic Medicine: A Quasi-Experimental Study.

To compare the effectiveness of flipped classroom and video-assisted learning techniques with didactic lectures in promoting clinical reasoning skills in Forensic Medicine. Quasi-experimental study. Place and Duration of the Study: Department of Forensic Medicine, Dow International Medical College and Dow University of Health Sciences, Karachi, Pakistan, from May to October 2023. The study included 114 third-year medical students divided into three predefined tutorial groups. Over four weeks, within the Forensic Medicine respiratory module, each group was taught one topic per week using a distinct teaching strategy: Traditional lectures (TL) for the first group, flipped classroom (FC) method for the second group, and video-assisted teaching (VAT) for the third group. Students' learning achievements and clinical reasoning skills were assessed through a pre-test, post-test, and revision post-test. Pre-test scores showed no significant differences among the groups (p = 0.655). However, post-test scores differed significantly (F2:111 = 11.93, p <0.001). Tukiye's test indicated that the mean score for the FC group was significantly different from the TL group (p = 0.003) and the VAT group (p <0.001), but there was no significant difference between the TL and VAT groups (p = 0.422). The revision post-test indicated a significant decrease in mean scores across all groups, regardless of the instructional approach (p <0.001). The FC approach for teaching clinical reasoning in Forensic Medicine shows promising results, effectively improving student performance and learning experience. Flipped classroom, Video-assisted teaching, Clinical reasoning, Forensic Medicine teaching.

Teaching and Learning Clinical Reasoning in Nursing Education: A Student Training Course.

Clinical reasoning is an essential component of nursing. It has emerged as a concept that integrates the core competencies of quality and safety education for nurses. In cooperation with five European partners, Instituto Politécnico de Setúbal (IPS) realized the "Clinical Reasoning in Nursing and Midwifery Education and Practice" project as part of the Erasmus+ project. As a partner, our team designed a multiplier event-the student training course. The aim of this report is to describe the construction and development of this clinical reasoning training course for nursing students. We outline the pedagogical approach of an undergraduate training course on clinical reasoning in 2023, which we separated into four stages: (i) welcoming, (ii) knowledge exploration, (iii) pedagogical learning, and (iv) sharing experience. This paper presents the learning outcomes of the collaborative reflection on and integration of the clinical reasoning concept among nursing students. This educational experience fostered reflection and discussion within the teaching team of the nursing department regarding the concept, models, and teaching/learning methods for clinical reasoning, with the explicit inclusion of clinical reasoning content in the nursing curriculum. We highlight the importance of implementing long-term pedagogical strategies in nursing education.

Perceived opportunities of clinical reasoning learning in postgraduate psychiatry training: Trainees' and faculty's perspectives.

Learning clinical reasoning is less effective in isolation of clinical environments because contextual factors are a significant component in the clinical reasoning process. This study investigated the differences in opinions between novice and expert clinicians on learning clinical reasoning in the workplace. The author used a cross-sectional online survey design to investigate the perceived learning of six clinical reasoning skills in 13 learning opportunities. Questionnaires were emailed to 41 postgraduate psychiatry trainee doctors and 37 faculty members. Data were analyzed descriptively. The Chi-square test was used to compare the responses of the two groups. Statistical significance was set at P < 0.05. The combined response rate was 73.07%. The two groups perceived the learning of advanced clinical reasoning skills to be lower than that of basic skills. There were significant differences in the perceived learning of basic clinical reasoning skills in self-study/exam preparations (P = 0.032), general hospital grand rounds (P = 0.049), and clinical rounds (P = 0.024 for consultant-led rounds and P = 0.038 for senior peer-led rounds). There were also significant differences in the perceived learning of advanced clinical reasoning skills among peer-led tutorials (P = 0.04), journal clubs (P = 0.006), morning reports (P = 0.002), and on-call duties (P = 0.031). The trainees showed a significant preference for structured learning environments rather than clinical environments, especially for advanced clinical reasoning skills. Trainees likely struggled with cognitive overload in clinical environments. Local postgraduate psychiatry programs will likely benefit from implementing multiple educational interventions that facilitate teaching and learning clinical reasoning in complex clinical environments.

Learning clinical reasoning skills during the transition from a medical graduate to a junior doctor

Introduction: The literature confirms the challenges of learning clinical reasoning experienced by junior doctors during their transition into the workplace. This study was conducted to explore junior doctors' experiences of clinical reasoning development and recognise the necessary adjustments required to improve the development of clinical reasoning skills. Methods: A hermeneutic phenomenological study was conducted using multiple methods of data collection, including semi-structured and narrative interviews (n=18) and post-consultation discussions (n=48). All interviews and post-consultation discussions were analysed to generate themes and identify patterns and associations to explain the dataset. Results: During the transition, junior doctors’ approach to clinical reasoning changed from a ‘disease-oriented’ to a ‘practice-oriented’ approach, giving rise to the ‘Practice-oriented clinical skills development framework’ helpful in developing clinical reasoning skills. The freedom to reason within a supportive work environment, the trainees’ emotional commitment to patient care, and their early integration into the healthcare team were identified as particularly supportive. The service-oriented nature of the internship, the interrupted supervisory relationships, and early exposure to acute care settings posed challenges for learning clinical reasoning. These findings highlighted the clinical teachers' role, possible teaching strategies, and the specific changes required at the system level to develop clinical reasoning skills among junior doctors. Conclusion: The ‘Practice-oriented clinical skills development framework’ is a valuable reference point for clinical teachers to facilitate the development of clinical reasoning skills among junior doctors. In addition, this research has provided insights into the responsibilities of clinical teachers, teaching strategies, and the system-related changes that may be necessary to facilitate this process. Keywords: Clinical Reasoning, Medical Decision Making, Medical Graduates, Junior Doctor Transition, Hermeneutic Phenomenology, Qualitative Research

Practical tips to improve bedside teaching using learning theories and clinical reasoning.

Bedside teaching strengthens the link between theory and practice. The tips given here, which were derived from various learning theories and models, aim to provide structure to bedside teaching and to make this format effective, even though empirical evidence is still missing for this specific setting. These 10 tips may not always be fully implemented in each bedside teaching, but they should be applied selectively for targeted students. In essence, they are more to be understood as a repertoire of effective methods and are intended to expand the literature and framework concepts already available.

Integrating a self-directed ultrasound curriculum for the internal medicine clerkship

BackgroundIncorporating ultrasound into the clinical curriculum of undergraduate medical education has been limited by a need for faculty support. Without integration into the clinical learning environment, ultrasound skills become a stand-alone skill and may decline by the time of matriculation into residency. A less time intensive ultrasound curriculum is needed to preserve skills acquired in preclinical years. We aimed to create a self-directed ultrasound curriculum to support and assess students’ ability to acquire ultrasound images and to utilize ultrasound to inform clinical decision-making.MethodsThird year students completed the self-directed ultrasound curriculum during their required internal medicine clerkship. Students used Butterfly iQ+ portable ultrasound probes. The curriculum included online modules that focused on clinical application of ultrasound as well as image acquisition technique. Students were graded on image acquisition quality and setting, a patient write-up focused on clinical decision-making, and a multiple-choice quiz. Student feedback was gathered with an end-of-course survey. Faculty time was tracked.ResultsOne hundred and ten students participated. Students averaged 1.79 (scale 0–2; SD = 0.21) on image acquisition, 78% (SD = 15%) on the quiz, and all students passed the patient write-up. Most reported the curriculum improved their clinical reasoning (72%), learning of pathophysiology (69%), and patient care (55%). Faculty time to create the curriculum was approximately 45 h. Faculty time to grade student assignments was 38.5 h per year.ConclusionsStudents were able to demonstrate adequate image acquisition, use of ultrasound to aid in clinical decision-making, and interpretation of ultrasound pathology with no in-person faculty instruction. Additionally, students reported improved learning of pathophysiology, clinical reasoning, and rapport with patients. The self-directed curriculum required less faculty time than prior descriptions of ultrasound curricula in the clinical years and could be considered at institutions that have limited faculty support.

Learning Clinical Reasoning in Forensic Medicine: A Scoping Review

Learning Clinical Reasoning in Forensic Medicine: A Scoping Review

Minding the gap: towards a shared clinical reasoning lexicon across the pre-clerkship/clerkship transition

ABSTRACT Teaching and learning of clinical reasoning are core principles of medical education. However, little guidance exists for faculty leaders to navigate curricular transitions between pre-clerkship and clerkship curricular phases. This study compares how educational leaders in these two phases understand clinical reasoning instruction. Previously reported cross-sectional surveys of pre-clerkship clinical skills course directors, and clerkship leaders were compared. Comparisons focused on perceived importance of a number of core clinical reasoning concepts, barriers to clinical reasoning instruction, level of familiarity across the undergraduate medical curriculum, and inclusion of clinical reasoning instruction in each area of the curriculum. Analyses were performed using the Mann Whitney U test. Both sets of leaders rated lack of curricular time as the largest barrier to teaching clinical reasoning. Clerkship leaders also noted a lack of faculty with skills to teach clinical reasoning concepts as a significant barrier (p < 0.02), while pre-clerkship leaders were more likely to perceive that these concepts were too advanced for their students (p < 0.001). Pre-clerkship leaders reported a higher level of familiarity with the clerkship curriculum than clerkship leaders reported of the pre-clerkship curriculum (p < 0.001). As faculty transition students from the pre-clerkship to the clerkship phase, a shared understanding of what is taught and when, accompanied by successful faculty development, may aid the development of longitudinal, milestone-based clinical reasoning instruction.

Transformation and Articulation of Clinical Data to Understand Students' and Health Professionals' Clinical Reasoning: Protocol for a Scoping Review.

There are still unanswered questions regarding effective educational strategies to promote the transformation and articulation of clinical data while teaching and learning clinical reasoning. Additionally, understanding how this process can be analyzed and assessed is crucial, particularly considering the rapid growth of natural language processing in artificial intelligence. The aim of this study is to map educational strategies to promote the transformation and articulation of clinical data among students and health care professionals and to explore the methods used to assess these individuals' transformation and articulation of clinical data. This scoping review follows the Joanna Briggs Institute framework for scoping reviews and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) checklist for the analysis. A literature search was performed in November 2022 using 5 databases: CINAHL (EBSCOhost), MEDLINE (Ovid), Embase (Ovid), PsycINFO (Ovid), and Web of Science (Clarivate). The protocol was registered on the Open Science Framework in November 2023. The scoping review will follow the 9-step framework proposed by Peters and colleagues of the Joanna Briggs Institute. A data extraction form has been developed using key themes from the research questions. After removing duplicates, the initial search yielded 6656 results, and study selection is underway. The extracted data will be qualitatively analyzed and presented in a diagrammatic or tabular form alongside a narrative summary. The review will be completed by February 2024. By synthesizing the evidence on semantic transformation and articulation of clinical data during clinical reasoning education, this review aims to contribute to the refinement of educational strategies and assessment methods used in academic and continuing education programs. The insights gained from this review will help educators develop more effective semantic approaches for teaching or learning clinical reasoning, as opposed to fragmented, purely symptom-based or probabilistic approaches. Besides, the results may suggest some ways to address challenges related to the assessment of clinical reasoning and ensure that the assessment tasks accurately reflect learners' developing competencies and educational progress. DERR1-10.2196/50797.

Reflecting on Students' Experiences of an Innovative Teaching Model During Aged Care Visit in Clinical Placements: A Qualitative Pilot Study.

Clinical placement teaching could be challenging due to time constraints, lack of effective teaching models and consensus approaches. Learner-centred approach facilitated deeper learning by demonstrating "seeing-patients-under-supervision" being ideal during Residential-Aged-Care-Facility (RACF)-visit in GP clinical placements. The study aimed to reflect on the students' experiences in aged-care visits by applying an innovative teaching model of "students-being-the-GP-clinician-in-charge-of-RACF-visit-ward-round-under-the-supervision-of-clinical-supervisor". Through students' reflections, this study identified 12 commonly managed RACF problems to be introduced into the curriculum to optimise clinical reasoning learning during RACF-visit. This qualitative study used online surveys and interviews. All participating students reported all the encountered cases during the RACF visit through an online survey. The participating students acted as GP in charge of all clinical interactions with patients, caregivers, and nurses during RACF visits and final management plan discussions with GP supervisors to ensure clinical-service safety and teaching-and-learning quality. The interview questionnaires applied standard-and-open-ended-questions to examine the impact of this innovative teaching model on clinical-reasoning-learning, clinical-competence-improvement, Objective Structured Clinical Exam (OSCE) preparation, limitations-from-students'-patients'-and-supervisors' perspectives, and intern readiness. An online survey summarising students' encountered cases was returned by 30 students. The 12 most commonly-managed problems were tabulated. Falls, urinary tract infections, and behavioural and psychological symptoms of dementia were the three most commonly-managed problems. All thirty students' reflections indicated the positive impact of the innovative-teaching-models on "Improving-Clinical-Reasoning-Learning", "Enhancing-Clinical-Competency", "Enriching-Salient-Learning-Points", "Facilitating-Feedback-Discussion-with-Supervisor", "Strengthening-OSCE-exam-preparation", "Understanding-the-Limitation-from-students'-patients'-and-supervisors'-perspectives", "Enabling-intern-readiness". Twelve students' individual reflections were demonstrated. This qualitative pilot study demonstrated through students' reflection that "Student-doctor-in-charge-of-nursing-home-round" is an innovative teaching model for clinical reasoning learning. This model extended the concepts of "cognitive-apprenticeship" in the context of modern medical education. Students' reflections and summary of commonly managed problems indicated the need for further study to verify the feasibility of implementing this teaching model in the formal curriculum and creating a RACF-visit-specific curriculum for students.

Performance of ChatGPT on Registered Nurse License Exam in Taiwan: A Descriptive Study.

(1) Background: AI (artificial intelligence) chatbots have been widely applied. ChatGPT could enhance individual learning capabilities and clinical reasoning skills and facilitate students' understanding of complex concepts in healthcare education. There is currently less emphasis on its application in nursing education. The application of ChatGPT in nursing education needs to be verified. (2) Methods: A descriptive study was used to analyze the scores of ChatGPT on the registered nurse license exam (RNLE) in 2022~2023, and to explore the response and explanations of ChatGPT. The process of data measurement encompassed input sourcing, encoding methods, and statistical analysis. (3) Results: ChatGPT promptly responded within seconds. The average score of four exams was around 51.6 to 63.75 by ChatGPT, and it passed the RNLE in 2022 1st and 2023 2nd. However, ChatGPT may generate misleading or inaccurate explanations, or it could lead to hallucination; confusion or misunderstanding about complicated scenarios; and languages bias. (4) Conclusions: ChatGPT may have the potential to assist with nursing education because of its advantages. It is recommended to integrate ChatGPT into different nursing courses, to assess its limitations and effectiveness through a variety of tools and methods.

The influence of Gamification on medical students’ diagnostic decision making and awareness of medical cost: a mixed-method study

BackgroundThe gamification of learning increases student enjoyment, and motivation and engagement in learning tasks. This study investigated the effects of gamification using decision-making cards (DMCs) on diagnostic decision-making and cost using case scenarios.MethodThirty medical students in clinical clerkship participated and were randomly assigned to 14 small groups of 2–3 medical students each. Decision-making was gamified using DMCs with a clinical information heading and medical cost on the front, and clinical information details on the back. First, each team was provided with brief clinical information on case scenarios. Subsequently, DMCs depending on the case were distributed to each team, and team members chose cards one at a time until they reached a diagnosis of the case. The total medical cost was then scored based on the number and contents of cards drawn. Four case scenarios were conducted. The quantitative outcomes including confidence in effective clinical decision-making, motivation to learn diagnostic decision-making, and awareness of medical costs were measured before and after our gamification by self-evaluation using a 7-point Likert scale. The qualitative component consisted of a content analysis on the benefits of learning clinical reasoning using DMCs.ResultConfidence in effective clinical decision-making, motivation to learn diagnostic decision-making, and awareness of medical cost were significantly higher after the gamification. Furthermore, comparing the clinical case scenario tackled last with the one tackled first, the average medical cost of all cards drawn by students decreased significantly from 11,921 to 8,895 Japanese yen. In the content analysis, seven advantage categories of DMCs corresponding to clinical reasoning components were extracted (information gathering, hypothesis generation, problem representation, differential diagnosis, leading or working diagnosis, diagnostic justification, and management and treatment).ConclusionTeaching medical students clinical reasoning using DMCs can improve clinical decision-making confidence and learning motivation, and reduces medical cost in clinical case scenarios. In addition, it can help students to acquire practical knowledge, deepens their understanding of clinical reasoning, and identifies several important clinical reasoning skills including diagnostic decision-making and awareness of medical costs. Gamification using DMCs can be an effective teaching method for improving medical students’ diagnostic decision-making and reducing costs.

The Relationship Between Self-Regulated Learning Competency and Clinical Reasoning Tendency in Medical Students.

Self-regulated learning (SRL) is essential to professional learning and practice across disciplines. However, the literature provides limited insights into how medical educators could leverage the SRL framework to support trainees' strategic processes in clinical reasoning activities. In this study, we investigated the relationship between SRL competency and clinical reasoning tendency as 64 medical students diagnosed a virtual patient in a computer-simulated environment. We further examined whether students with different profiles of SRL competency and clinical reasoning tendency differed in their behavioral patterns and performance. The results suggested that SRL competency positively predicted clinical reasoning tendency. Enhancing medical students' SRL competency, especially their self-reflection skills, could increase the tendency toward relying on an analytic approach to clinical reasoning. Moreover, we identified two groups of students (i.e., analytic SRL learners, and non-analytic, low SRL learners) using K-means clustering analysis. The two groups of students differed in their behavioral patterns in clinical reasoning, as revealed by lag sequential analysis. Furthermore, analytic SRL learners ordered more relevant lab tests than non-analytic low SRL learners in clinical reasoning. This study has methodological and practical implications.

Qualitative content analysis of the highly cited articles in medical education: Trends and characteristics associated with citation of published studies in medical education research

Purpose To explore and describe the highly cited articles’ themes of research in medical education and to provide an insight into and reflection on which the elites of medical education society invested their energies from 2009 to 2018. Methods An in-depth content analysis as a research technique for the objective, systematic, and quantitative description of the manifest content of communication was used to quantitatively assess subject interests, methods, and other characteristics associated with citation of published studies in medical education research. Meaning units were compacted and coded with labels and categories in two phases. Results Among a variety of topics, methods, and strategies, 764 codes, 24 descriptive themes, and seven categories were extracted from the content analysis as the most prominent. Categories of medical education research were: modern technologies updating in medical education; learner performance improvement; sociological aspects of medical education; clinical reasoning; research methodology concerns of medical education; instructional design educational models; and professional aspects of medical education. Conclusions Commitment to continuous revision of educational emphasis and concerns on technological, sociological, and methodological concerns were the most repeated components of the highly cited articles that were ascertained through increased structure course designs and instructional strategies of the flipped classrooms to realize clinical reasoning and performance improvement. Practice points It becomes increasingly urgent to understand how various educational processes and technology-enhanced innovations affect each other and do or could influence learning outcomes, clinical reasoning, and performance improvement. Modern technologies as techniques to administer the changing educational and social environment, can supply and support the infrastructure and basis for operating many of the challenges in preparing the medical education community for the future. Research in the medical education context in the future should be focused on the inter-relationships of prominent and marginalized educational themes and categories.

Transformative learning in clinical reasoning: a meta-synthesis in undergraduate primary care medical education

ABSTRACT Clinical reasoning is a vital medical education skill, yet its nuances in undergraduate primary care settings remain debated. This systematic review explores clinical reasoning teaching and learning intricacies within primary care. We redefine clinical reasoning as dynamically assimilating and prioritising synthesised patient, significant other, or healthcare professional information for diagnoses or non-diagnoses. This focused meta-synthesis applies transformative learning theory to primary care clinical reasoning education. A comprehensive analysis of 29 selected studies encompassing various designs made insights into clinical reasoning learning dimensions visible. Primary care placements in varying duration and settings foster diverse instructional methods like bedside teaching, clinical consultations, simulated clinics, virtual case libraries, and more. This review highlights the interplay between disease-oriented and patient-centred orientations in clinical reasoning learning. Transformative learning theory provides an innovative lens, revealing stages of initiation, persistence, time and space, and competence and confidence in students’ clinical reasoning evolution. Clinical teachers guide this transformation, adopting roles as fortifiers, connoisseurs, mediators, and monitors. Patient engagement spans passive to active involvement, co-constructing clinical reasoning. The review underscores theoretical underpinnings’ significance in shaping clinical reasoning pedagogy, advocating broader diversity. Intentional student guidance amid primary care complexities is vital. Utilising transformative learning, interventions bridging cognitive boundaries enhance meaningful clinical reasoning learning experiences. This study contributes insights for refining pedagogy, encouraging diverse research, and fostering holistic clinical reasoning development.

Hybrid PBL and Pure PBL: Which one is more effective in developing clinical reasoning skills for general medicine clerkship?-A mixed-method study.

This study aims to compare the effectiveness of Hybrid and Pure problem-based learning (PBL) in teaching clinical reasoning skills to medical students. The study sample consisted of 99 medical students participating in a clerkship rotation at the Department of General Medicine, Chiba University Hospital. They were randomly assigned to Hybrid PBL (intervention group, n = 52) or Pure PBL group (control group, n = 47). The quantitative outcomes were measured with the students' perceived competence in PBL, satisfaction with sessions, and self-evaluation of competency in clinical reasoning. The qualitative component consisted of a content analysis on the benefits of learning clinical reasoning using Hybrid PBL. There was no significant difference between intervention and control groups in the five students' perceived competence and satisfaction with sessions. In two-way repeated measure analysis of variance, self-evaluation of competency in clinical reasoning was significantly improved in the intervention group in "recalling appropriate differential diagnosis from patient's chief complaint" (F(1,97) = 5.295, p = 0.024) and "practicing the appropriate clinical reasoning process" (F(1,97) = 4.016, p = 0.038). According to multiple comparisons, the scores of "recalling appropriate history, physical examination, and tests on clinical hypothesis generation" (F(1,97) = 6.796, p = 0.011), "verbalizing and reflecting appropriately on own mistakes," (F(1,97) = 4.352, p = 0.040) "selecting keywords from the whole aspect of the patient," (F(1,97) = 5.607, p = 0.020) and "examining the patient while visualizing his/her daily life" (F(1,97) = 7.120, p = 0.009) were significantly higher in the control group. In the content analysis, 13 advantage categories of Hybrid PBL were extracted. In the subcategories, "acquisition of knowledge" was the most frequent subcategory, followed by "leading the discussion," "smooth discussion," "getting feedback," "timely feedback," and "supporting the clinical reasoning process." Hybrid PBL can help acquire practical knowledge and deepen understanding of clinical reasoning, whereas Pure PBL can improve several important skills such as verbalizing and reflecting on one's own errors and selecting appropriate keywords from the whole aspect of the patient.