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The Adventures of Fundi Intervention Based on the Cognitive and Emotional Processing in Attention Deficit Hyperactive Disorder Patients

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What is so difficult about managing clinical reasoning difficulties?

Marie-Claude Audétat¹, Valérie Dory, Mathieu Nendaz

¹Départment of Family and Emergency Medicine and CPASS (Centre de Pédagogie appliquée aux Sciences de la Santé), Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada. mcaudetat@sympatico.ca

Medical Education

|January 14, 2012

Summary

Clinical educators often struggle to address clinical reasoning difficulties, viewing residency as an apprenticeship rather than a structured educational program. A paradigm shift and faculty development are needed to improve how these challenges are managed.

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Area of Science:

Medical Education
Clinical Reasoning
Healthcare Professional Development

Background:

Clinical reasoning is crucial for medical competence, but difficulties are often identified late in training.
Clinical educators face challenges balancing clinical and educational roles, with limited understanding of how they manage reasoning difficulties.
This study explores the current state and influencing factors of managing clinical reasoning difficulties among educators.

Purpose of the Study:

To describe the current management of clinical reasoning difficulties in various clinical teaching settings.
To explore factors influencing clinical educators' behavior in addressing these difficulties.

Main Methods:

Four focus groups were conducted with 26 clinical educators across general practice, internal medicine, and emergency medicine in Belgium and Switzerland.
Transcripts were analyzed using Fishbein's integrative model of behavior prediction.
Findings were validated by experienced faculty members.

Main Results:

The identification and remediation of clinical reasoning difficulties were unstructured across settings.
Educators' beliefs, rooted in an apprenticeship model, influenced their behavior, limiting their role to role-modeling and expressing skepticism about remediation.
Environmental constraints reinforced a paradigm of residency as an apprenticeship focused on clinical duties, not education.

Conclusions:

A paradigm shift is necessary, viewing residency as a structured educational program rather than an apprenticeship, to improve the management of clinical reasoning difficulties.
Faculty development programs should integrate skill development with belief modification for clinical educators.