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Teaching Clinical Reasoning in the Preclinical Period.

Renee Mallory1, Joseph M Maciuba1, Michael Roy1

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Summary

This study introduces a preclinical clinical reasoning course for medical students, emphasizing diagnostic skills through case-based learning. The curriculum effectively enhances students' ability to reason and diagnose, proving adaptable for various medical education settings.

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Area of Science:

  • Medical Education
  • Clinical Reasoning Development
  • Diagnostic Skills Training

Background:

  • Developing clinical reasoning is crucial for medical students to become adept diagnosticians.
  • A lack of detailed literature exists on effective preclinical clinical reasoning curricula.
  • Medical educators face challenges in designing, delivering, and assessing such programs.

Purpose of the Study:

  • To present the Introduction to Clinical Reasoning course at Uniformed Services University of the Health Sciences.
  • To describe a model for teaching clinical reasoning throughout the preclinical curriculum.
  • To provide a framework for developing diagnostic reasoning skills in early medical learners.

Main Methods:

  • A 15-month longitudinal course integrating interactive lectures and 28 case-based small group activities.
  • Curriculum grounded in script theory, focusing on diagnostic reasoning components.
  • Utilized diverse assessment methods including participation, knowledge, and application evaluations.
  • Employed clinical faculty, residents, and senior medical students as facilitators.

Main Results:

  • The course provides repeated exposure to cases to foster clinical reasoning development.
  • Student and faculty feedback indicates the course is highly effective and engaging.
  • The curriculum successfully builds semantic competence, problem list generation, and differential diagnosis formulation.

Conclusions:

  • The Introduction to Clinical Reasoning course effectively promotes diagnostic reasoning skills in preclinical students.
  • This model demonstrates how clinical reasoning can be integrated without extensive faculty training.
  • The course structure is adaptable for various instructional formats and topics in medical education.