The Development and Evaluation of a Clinical Reasoning Case for Second-Year Medical Students

Clinical reasoning is a cornerstone of diagnostic and therapeutic decision-making, yet it is infrequently taught in preclinical medical education and is often taught implicitly.

To address this gap, we developed a clinical reasoning case focused on hematochezia as part of a year-long longitudinal clinical reasoning course for second-year preclinical medical students. The session combined large-group instruction with small-group learning activities that emphasized core reasoning skills, including problem representation, illness scripts, differential diagnoses, and diagnostic and management planning. A pre- and postintervention survey measured changes in students' confidence and attitudes about clinical reasoning skills and concepts and knowledge of hematochezia.

Of the 123 medical students who attended the case, 92 completed both surveys (74.8% response rate). Confidence improved significantly in all domains (P < .01 for problem representation; P < .0001 for others). Students' attitudes toward case-based learning also improved (P < .0001). Knowledge scores increased for all items, with 1 reaching statistical significance (P < .05).

Integrating formal clinical reasoning instruction into preclinical medical education through case-based learning is an effective strategy for teaching second-year medical students essential clinical reasoning skills.