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How to … Coach Problem Representation to Strengthen Diagnostic Reasoning in Trainees.

Cody Clary1, Adam Cohen2, Satid Thammasitboon3

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Problem representation (PR), a key diagnostic skill, is often underdeveloped in medical training. The Assessment of Reasoning Tool-Reconstructed (ART-R) offers a coaching framework to improve PR, enhancing diagnostic reasoning and patient safety.

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Area of Science:

  • Medical Education
  • Clinical Reasoning
  • Diagnostic Skills

Background:

  • Problem representation (PR) is crucial for diagnostic reasoning but often inadequately developed in medical trainees.
  • Difficulties in transforming clinical data into effective PR can impede communication, reasoning, and patient safety.

Purpose of the Study:

  • To introduce the Assessment of Reasoning Tool-Reconstructed (ART-R) as a coaching rubric for improving PR skills in clinical teaching.
  • To provide a structured framework for educators to guide trainees in refining their PR.

Main Methods:

  • The ART-R framework focuses coaching on three key elements: clarity of the problem, inclusion of relevant findings, and precise medical terminology.
  • A micro-coaching approach embeds brief prompts into clinical rounds to encourage refinement of PR.
  • Repeated practice with ART-R assists trainees in developing abstracted representations for hypothesis generation.

Main Results:

  • The ART-R framework facilitates structured feedback on PR during clinical teaching.
  • This micro-coaching strategy is a practical, low-burden method for enhancing diagnostic reasoning.
  • Trainees improve their ability to create concise, diagnostically relevant problem representations.

Conclusions:

  • Coaching problem representation using the ART-R is an effective strategy for strengthening diagnostic reasoning in medical trainees.
  • Integrating ART-R into patient presentations can significantly improve diagnostic skills.
  • Enhanced PR contributes to better clinical communication and patient safety.