Analysis of Expert Feedback to Determine Intellectual Standards for Student Pharmacist Clinical Reasoning Development

Abstract

Objectives: Clinical reasoning (CR) is one of the most important skill sets to be instilled in pharmacy learners. Feedback has been proposed as a pedagogy to improve CR skills, however, essential components of CR have yet to be determined within pharmacy education. This study sought to identify these essential components that could be used to help focus CR feedback to realize the desired outcomes of the Pharmacists' Patient Care Process (PPCP). Methods: Deidentified clinical reasoning "Keep," "Start," or "Stop" (KSS) feedback comments from third professionalyear student written CR Think-Alouds, with sections mapped to the PPCP, was coded by two independent investigators according to proposed essential components of CR using an adapted grounded theory approach. Investigators could inductively add codes after conferring with the other. Coded feedback was analyzed using a summative content approach. Inter-coder reliability was calculated via Holsti index. Results: Five essential components of CR were identified after analysis of 635 KSS comments. The five essential components of CR were coded 1178 times. "Accurate," "Concise," "Specific," and "Thorough" were identified a priori while "Connected" was discovered during feedback comment review. Literature analysis added supporting data to these results through the Paul-Elder Critical Thinking Framework. To maintain consistency within educational language, these essential components will be called intellectual standards moving forward. Conclusion: This novel study successfully identified five key intellectual standards of CR. These intellectual standards provide a framework for pharmacy educators to consistently focus feedback to improve student CR skills. Future research for other intellectual standards pertinent to experiential education is imperative.