Clinical reasoning as a threshold skill

Pinnock, Ralph; Anakin, Megan; Jouart, Madelyne

doi:10.1080/0142159x.2019.1569754

Cited by 16 publications

(29 citation statements)

References 32 publications

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“…Clinical situations in universities and tertiary hospitals can incorporate medical students and residents into their medical teams and gradually demonstrate the processes of clinical reasoning through learners' active participation. 16 Family medicine instruction in community hospitals requires the development and implementation of an orientation session for CBME that prepares students for the learning environment and what is expected of them. In the CBME they received in rural community hospitals, they were gradually exposed to multiple areas of medicine and guided toward self-directed learning, which was new for them.…”

Section: Discussionmentioning

confidence: 99%

Strengths and Challenges for Medical Students and Residents in Rural Japan

Ohta¹,

Ryu²,

Katsube³

et al. 2021

Fam Med

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Background and Objectives: In Japan, family medicine training is driven by community-based medical education (CBME) and is often provided in rural community hospitals and clinics. Although CBME’s positive relationship to family medicine in rural community hospitals is proven, the learning processes of medical students and residents in rural community hospitals needs investigating. The objective of this study was to reveal medical students’ and residents’ changing motivations and learning behaviors, as well as the factors underpinning their transition between medical schools or tertiary hospitals and rural community hospitals. Methods: Over 2 years, the researchers conducted one-on-one interviews with 50 medical students and 30 residents participating in family medicine training at a rural community hospital, and analyzed the difficulties the participants encountered and how they overcame them. The interviews were audio recorded and transcribed verbatim. We used grounded theory in the data analysis to clarify the findings. Results: Three key themes emerged: educational background, changing environment, and factors driving the learning cycle. Participants had difficulties in overcoming differences between their previous education and their CBME, particularly regarding expected roles and the variety of medical issues. They overcame their difficulties through cognitive apprenticeships and legitimate peripheral participation enhanced by daily reflection. Conclusions: In rural community hospitals, participants struggled to adapt to the wider practice range and the more interactive relationship with educators. Cognitive apprenticeships and legitimate peripheral participation, supported by constant reflection between learners and clinical teachers, can facilitate learning, leading to more effective learning and practice of family medicine in rural areas.

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Section: Discussionmentioning

confidence: 99%

Strengths and Challenges for Medical Students and Residents in Rural Japan

Ohta¹,

Ryu²,

Katsube³

et al. 2021

Fam Med

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show abstract

“…8,17,19 A recent qualitative study suggested that students' find the acquisition of clinical reasoning skills troublesome and that they require repeated practice under supervision. 20 Continuity of feedback supports this repeated practice and is increasingly recognized as an important mechanism through which positive student learning outcomes can be achieved on clinical placements. 21,22 Feedback has been suggested as the most critical factor to the development of clinical diagnostic reasoning in novices.…”

Section: Discussionmentioning

confidence: 99%

<p>Developing Medical Students’ Broad Clinical Diagnostic Reasoning Through GP-Facilitated Teaching in Hospital Placements</p>

Bansal¹,

Singh²,

Thompson³

et al. 2020

AMEP

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Purpose: Graduating medical students need broad clinical diagnostic reasoning skills that integrate learning across clinical specialties to deal with undifferentiated patient problems. The opportunity to acquire these skills may be limited during clinical placements on increasingly specialized hospital wards. We developed an intervention of regular general practitioner (GP) facilitated teaching in hospital placements to enable students to develop broad clinical diagnostic reasoning. The intervention was piloted, refined and delivered to a whole cohort of medical students at the start of their third year. This paper examines whether students perceived opportunities to improve their broad diagnostic clinical reasoning through our intervention. Methods: GP-facilitated teaching sessions were delivered weekly in hospital placements to small groups of 6-8 students for 90 mins over 6 weeks. Students practiced clinical reasoning with real patient cases that they encountered on their placements. Evaluation of learning outcomes was conducted through a student questionnaire using Likert scales with free-text boxes for additional explanation. Focus groups were conducted to gain a more in-depth understanding of student perspectives. Results: As high as 87% of students agreed that their broad clinical diagnostic reasoning ability had improved. Thematic analysis of the qualitative data revealed four factors supporting this improvement: practicing the hypothetico-deductive method, using real patient cases, composing student groups from different speciality placements and the breadth of the facilitators' knowledge. Students additionally reported enhanced person-centredness in terms of understanding the patient's perspective and journey. Students perceived that the added value of general practitioner facilitators lay in their broad knowledge base and knowledge of patient needs in the community. Conclusion: Our results suggest that medical students can develop broad clinical diagnostic reasoning skills in hospital settings through regular GP-facilitated teaching. Our approach has the advantage of working within the established curricular format of hospital placements and being deliverable at scale to whole student cohorts.

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“…However, no single theory seems to account for all aspects of CR. 20 To better appreciate the complexities and evolution of CR in students, it can be helpful to consider CR as a threshold skill. 20 A threshold skill is integrative (ie,…”

Section: Teaching Clinical Reasoningmentioning

confidence: 99%

“…3,21,23 Consider utilizing cases or situations that slowly progress from simple to complex. 2,20 This will allow student pharmacists to generate and integrate knowledge, practice cognitive processes related to CR, and develop experience. A specific strategy may be selected by considering learner level and learning activity.…”

Section: A J P Ementioning

confidence: 99%

Enhancing the “What” and “Why” of the Pharmacists’ Patient Care Process With the “How” of Clinical Reasoning

Newsom

Augustine

Funk

et al. 2022

American Journal of Pharmaceutical Education

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Objectives. Clinical reasoning (CR) is integral to the provision of patient-centered care as outlined in the Pharmacists' Patient Care Process (PPCP). However, the PPCP was not created to foster CR in student pharmacists and cannot be the sole tool used to characterize or cultivate these skills. This article seeks to describe elements of CR, the relationship between CR and PPCP, and concepts from the CR literature that should inform the teaching of CR skills. Findings. Key elements of the PPCP were identified in CR definitions, but differences emerged. The literature supports CR as a bidirectional, fluid process that is highly collaborative. Effective CR requires multiple types of "thinking", interaction with others and the environment, self-assessment, and a tolerance for nuance or ambiguity. Teaching strategies can be used in the didactic and experiential setting to target the cognitive and contextual factors associated with CR. Summary. Educators should consult the CR literature to enhance our understanding of CR in seeking to teach, model, and foster these skills in our students. Future scholarship should include the development of models to support CR within the profession of pharmacy, adoption and experimentation with CR teaching techniques, and valuation of the utility of various assessment tools and processes.

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Clinical reasoning as a threshold skill

Cited by 16 publications

References 32 publications

Strengths and Challenges for Medical Students and Residents in Rural Japan

Strengths and Challenges for Medical Students and Residents in Rural Japan

<p>Developing Medical Students’ Broad Clinical Diagnostic Reasoning Through GP-Facilitated Teaching in Hospital Placements</p>

Enhancing the “What” and “Why” of the Pharmacists’ Patient Care Process With the “How” of Clinical Reasoning

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