Assessing Clinical Reasoning Ability in Fourth-year Medical Students via an Integrative Group History-taking Workshop With an Individual Reasoning Teaching Programme

Abstract

Background: The most important factor in evaluating a physician’s competence is strong clinical reasoning ability, leading to correct principal diagnoses. The process of clinical reasoning includes history taking, physical examinations, validating medical records, and determining a final diagnosis. In this study, we designed a teaching programme to evaluate the clinical reasoning competence of fourth-year medical students.Methods: We created five patient scenarios for our standardised patients, including haemoptysis, abdominal pain, fever, anaemia, and chest pain. A group history-taking workshop with individual reasoning principles was implemented to teach and evaluate students’ abilities to take histories, document key information, and arrive at the most likely diagnosis. Residents were trained to act as teachers, and a post-study questionnaire was employed to evaluate the students’ satisfaction with the training programme.Results: A total of 76 students, five teachers, and five standardised patients participated in this clinical reasoning training programme. The average history-taking score was 64%, the average key information number was 7, the average diagnosis number was 1.1, and the average correct diagnosis rate was 38%. Standardised patients presenting with abdominal pain (8.3%) and anaemia (18.2%) had the lowest diagnosis rates. The scenario of anaemia presented the most difficult challenge for students in history taking (3.5/5) and clinical reasoning (3.5/5). The abdominal pain scenario yielded even worse results (history taking: 2.9/5 and clinical reasoning 2.7/5). We found a correlation in the clinical reasoning process between the correct and incorrect most likely diagnosis groups (group history-taking score, p=0.045; key information number, p=0.009 and diagnosis number, p=0.004). The post-study questionnaire results indicated significant satisfaction with the teaching programme (4.7/5) and the quality of teacher feedback (4.9/5).Conclusions: We concluded that the clinical reasoning skills of fourth-year medical students benefited from this training programme, and the lower correction of the most likely diagnosis rate found with abdominal pain, anaemia, and fever might be due to a system-based teaching programme in fourth-year medical students; cross-system remedial reasoning training is recommended for fourth-year medical students in the future.