Clinical Reasoning in the Primary Care Setting: Two Scenario-Based Simulations for Residents and Attendings

Area of Science:

• Medical Education
• Clinical Reasoning Assessment
• Physician Training

Background:

• Assessing and developing clinical reasoning in physicians is crucial for patient care.
• Existing methods may not fully capture the complexity of real-world clinical decision-making.
• Outpatient settings present unique challenges for evaluating diagnostic and therapeutic reasoning.

Purpose of the Study:

• To develop and implement tools for assessing clinical reasoning in physicians within an outpatient clinic.
• To provide educators and researchers with a structured approach to analyze physician thought processes.
• To create realistic simulation scenarios that incorporate case ambiguity and contextual factors.

Main Methods:

• Developed two scenario-based simulations (diabetes, angina) with inherent complexity.
• Implemented an open-ended postencounter form and a think-aloud reflection protocol.
• Utilized these tools in a research context with interns, residents, and attending physicians.

Main Results:

• Physicians considered an average of 4.0-4.3 differential diagnoses per scenario.
• Participants engaged in 3.3-3.5 reflective reconsiderations of their thinking.
• High authenticity ratings (4-5/5) and moderate cognitive load (6.2-6.6/10) were reported.

Conclusions:

• The developed tools effectively create a complex environment for exploring and teaching clinical reasoning.
• Scenario ambiguity and contextual factors enhance the assessment of physician decision-making.
• These resources are valuable for both educational and research purposes in medical training.