Clinical Reasoning Tasks and Resident Physicians: What Do They Reason About?

Area of Science:

• Medical Education
• Clinical Reasoning
• Internal Medicine

Background:

• A recently developed framework outlines 24 clinical reasoning tasks involved in patient encounters.
• Understanding the specific reasoning processes employed by residents is crucial for effective medical training.

Purpose of the Study:

• To investigate the clinical reasoning tasks used by internal medicine residents when managing straightforward clinical cases.
• To apply a framework of 24 diagnostic and therapeutic reasoning tasks to analyze resident decision-making.

Main Methods:

• Ten internal medicine residents viewed three video-recorded clinical encounters with common diagnoses.
• Participants completed post-encounter forms and underwent think-aloud protocols.
• Transcripts were analyzed using constant comparative analysis and iterative coding based on the clinical reasoning task framework.

Main Results:

• Residents used 14 distinct clinical reasoning tasks across the three cases, primarily related to framing the encounter and diagnosis.
• The sequence of task utilization varied among residents and cases.
• Average tasks per case ranged from 4.4 to 4.7, with repeated use of certain tasks.

Conclusions:

• Clinical reasoning in residents appears to be a varied and non-sequential process.
• The findings suggest a need to refine the existing framework to better capture the full spectrum of reasoning tasks in clinical practice.