Exploring Differences in Clinical Decisions Between Medical Students and Expert Clinicians

Area of Science:

• Medical Education
• Cognitive Science
• Learning Sciences

Background:

• Challenges persist in integrating clinical reasoning theory and practice in medical education.
• Existing theoretical models of clinical reasoning often lack practical application in teaching and assessment.
• This study addresses the gap by comparing clinical reasoning in students and experts using a problem-solving framework.

Purpose of the Study:

• To compare clinical reasoning practices and decisions between medical students and expert clinicians.
• To identify specific differences in the diagnostic process between these groups.
• To provide a framework for improving clinical reasoning instruction.

Main Methods:

• A questionnaire based on a learning sciences problem-solving framework was developed for a pediatric infectious disease case.
• Data were collected from 10 expert clinicians and 74 medical students at Stanford University (2019-2023).
• Deductive content analysis was used to code responses and identify patterns in clinical reasoning practices and decisions.

Main Results:

• A detailed framework of clinical reasoning was empirically developed, comprising nine practices and twenty-nine decisions.
• Significant differences between experts and students were observed in ten key decisions across four practices.
• These practices included differential diagnosis formulation, diagnostic plan execution, data reassessment, and solution review.

Conclusions:

• Nuanced differences in clinical reasoning between medical students and expert physicians were identified within a unified problem-solving framework.
• Understanding these differences can inform the development of targeted instructional materials and assessment tools.
• This research aids educators in fostering essential clinical reasoning skills in medical trainees.