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Japanese medical students rapidly improved clinical reasoning skills through an outpatient clerkship emphasizing reflective practice. This program significantly enhanced diagnostic abilities and learning motivation, as evidenced by higher assessment scores.

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Area of Science:

  • Medical Education
  • Clinical Reasoning Development
  • Outpatient Care Settings

Background:

  • Clinical reasoning acquisition is often linked to patient encounters.
  • Outpatient settings offer unique learning opportunities for medical students.
  • Reflective practice is a key component in developing clinical expertise.

Purpose of the Study:

  • To establish and evaluate a clinical clerkship course for Japanese medical students in an outpatient setting.
  • To enhance students' clinical reasoning abilities through structured learning and reflective practice.
  • To assess the effectiveness of the clerkship using objective and subjective measures.

Main Methods:

  • Students diagnosed new patients within 20 minutes, presenting cases using the SNAPPS (Summarize the case, Narrow the differential, Analyze the differential, Probe the preceptor, Plan management, and Select an issue for self-directed learning) method.
  • Faculty provided feedback using the 1-minute preceptor method and mini-clinical evaluation exercises (mini-CEX).
  • Clinical reasoning was assessed via objective structured clinical examination (OSCE), script concordance test (SCT), and comparison with a control group (MCQ).

Main Results:

  • Students in the clerkship program achieved significantly higher scores on mini-CEX, SCT, and OSCE compared to the control group.
  • The program fostered daily reflection, leading to positive student feedback.
  • Participants demonstrated enhanced diagnostic decision-making and clinical reasoning skills.

Conclusions:

  • A clinical clerkship in an outpatient setting with ample reflective practice significantly improves medical students' clinical reasoning.
  • The program structure facilitated rapid skill acquisition and increased student motivation.
  • Reflective practice is a crucial element for developing effective clinical reasoning in medical trainees.