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Identifying developmental features in students' clinical reasoning to inform teaching
Ralph Pinnock1, Megan Anakin1, Julie Lawrence2
1a Medical Education Unit , The Office of the Dean , Dunedin , New Zealand.
Medical Teacher
|April 29, 2018
Summary
Early medical trainees benefit from different clinical reasoning methods. Later trainees, with developed illness scripts, can utilize the serial cue approach for better learning.
Area of Science:
- Medical Education
- Cognitive Science in Medicine
Background:
- Clinical reasoning education varies.
- Whole-case and serial-cue are common teaching methods.
- Empirical evidence guiding method selection is limited.
Purpose of the Study:
- To observe how students at different training levels take patient histories.
- To infer student clinical reasoning processes during history taking.
Main Methods:
- 23 students across training stages interviewed simulated patients.
- Simulated patients presented with straightforward and complex cases.
- Reasoning was inferred from history-taking techniques and self-reported thinking.
Main Results:
- Early trainees take generic histories.
- Later trainees develop focused histories, information recall, and data analysis skills.
- Advanced trainees can analyze data concurrently with information gathering.
Conclusions:
- Novice trainees cannot analyze data during history taking.
- Developing illness scripts enables students to benefit from the serial-cue teaching method.
- Teaching methods should align with trainee's cognitive development stage.