A Targeted Clinical Reasoning Remediation Program for Residents and Fellows in Need

Area of Science:

• Medical Education
• Cognitive Science

Background:

• Lack of standardized clinical reasoning remediation processes.
• Need for individualized interventions for struggling trainees.

Purpose of the Study:

• Describe a novel, targeted assessment and coaching process for clinical reasoning remediation.
• Evaluate the feasibility and outcomes of this individualized intervention program.

Main Methods:

• Residents and fellows with performance concerns referred to COACH (Committee on Achieving Competence Through Help).
• Assessment by remediation expert and, for a subset, a clinical reasoning coach.
• Development of individualized remediation plans and reassessment post-intervention.

Main Results:

• 33% of 114 referred trainees (38 individuals) had clinical reasoning deficiencies.
• Most common deficit: hypothesis generation (42%).
• 87% of remediated trainees (33 of 38) are in good academic standing.

Conclusions:

• The described program offers a feasible, targeted approach to clinical reasoning remediation.
• Early hypothesis generation is a frequent area of difficulty requiring intervention.