Embedding Clinical Reasoning into an Undergraduate Medical Curriculum: A Multi-Stakeholder Perspective

Medical educators agree on the importance of teaching clinical reasoning (CR) at the undergraduate level with a deliberate curricular approach. Despite recent recommendations on how to reach this objective, there are limited empirical data on how it unfolds once implemented. This study advanced the understanding of how a deliberately designed CR curriculum was experienced and contributed to students' CR development. Our study sought to add to the conversation on undergraduate CR curricula by providing data that could be relevant and applicable across other learning contexts.

We conducted a qualitative descriptive study in the context of a competency-based medical program that is interdisciplinary, with spiral integration. Through nine focus groups, we sought the experience of curriculum designers, teachers, and students on how the CR curriculum embedded into the program contributes to students' CR development. Data were analyzed using a thematic approach.

We identified four overarching themes: 1- Global coherence of the curriculum around the development of CR; 2- Interdisciplinary integration to enhance CR development; 3-Cognitive load of students and pervasive time constraints; 4- Active teaching methods that promote the development of CR.

From the different stakeholders' perspectives, students acquired various knowledge types in CR domains and applied them to problem-solving. Stakeholders' experiences with the implemented CR curriculum matched the initial intent but presented some challenges as well. These findings underscored both the feasibility and the complexity of embedding CR within an undergraduate medical curriculum. Careful attention is required to support students and teachers.