'Place' and clinical reasoning development in context: An ethnographic case study

Area of Science:

• Medical Education
• Clinical Reasoning
• Sociology of Health

Background:

• Place-Based Medical Education (PBME) aims to train physicians for underserved areas, but the role of 'place' is conceptual.
• Previous research highlighted a lack of empirical evidence on how place features influence Clinical Reasoning (CR) development.
• The HARD framework was proposed to guide research on place and CR.

Purpose of the Study:

• To empirically investigate how distinct features of place impact the development of clinical reasoning in medical students.
• To build upon the HARD framework by examining the influence of context on CR.
• To explore the relationship between CR development, sense-of-place, place-dependence, and place-identity.

Main Methods:

• An ethnographic case study was conducted in General Practice (GP) settings.
• Data collection included 120 hours of participant observation, 57 interviews, and analysis of curriculum documents and artefacts.
• Thematic analysis of the rich data set was informed by the HARD model and a 'sense-of-place' interpretive lens.

Main Results:

• Five domains of CR development were identified, with each student exhibiting a unique, placement-influenced pathway.
• Empirical evidence demonstrated how CR development in context shapes place-dependence and place-identity.
• CR development was found to be cognitive, relational, and socio-material.

Conclusions:

• Findings align with the HARD conceptualisation, emphasizing CR development as a multifaceted process.
• This transtheoretical perspective enhances understanding of place distinctiveness in medical training.
• Attention to context is crucial for designing and delivering effective physician training in PBME settings and beyond.