Narrative analysis to track the development of clinical reasoning during residency

Reflective narratives are valuable pedagogical tools that document and develop clinical reasoning. The purpose of this study was to investigate (through thematic analysis of reflective narratives) whether residents who were exposed to a specific clinical reasoning strategy showed development in the type and number of reasoning strategies used over the course of residency training.

This retrospective analysis used narrative research and thematic analysis of reflective narratives written by five residents over the course of a 12-month orthopaedic residency program. Narrative research involves the analysis of stories that are in text form. Residents were introduced into the clinical reasoning strategies (CRS) model, which describes eight types of reasoning strategies used by expert physical therapists: diagnostic, narrative, intervention procedures, interactive, collaborative, reasoning about teaching, predictive, and ethical reasoning. Researchers coded resident narratives for the types of CRS used by residents, and then analyzed the code frequency to describe the development of resident clinical reasoning.

Researchers identified seven of the eight CRS strategies in resident narratives: diagnostic, narrative, reasoning about intervention procedures, interactive, collaborative, reasoning about teaching, and predictive reasoning. Residents used an average of 4.8 CRS at the beginning of residency and 5.8 at the end of the residency training. Reasoning about diagnostic and intervention procedures were used most frequently. Collaborative reasoning showed the most development, with 100% of the residents leveraging collaborative reasoning by the end of the residency.

Narratives serve as valuable pedagogical tools to help residents engage in reflective processes and understand the context of caring for their patients. This study illustrates using qualitative data analysis to evaluate the development of clinical reasoning skills throughout residency training. Clinical narratives can both foster and provide valuable insights into the development of clinical reasoning skills.