Development of clinical reasoning from the basic sciences to the clerkships: a longitudinal assessment of medical students' needs and self-perception after a transitional learning unit

Abstract

To ease students' transition from the preclinical to clinical years, a learning unit should give them the opportunity to train their clinical reasoning processes on standardised and prototypical problems, before encountering real patients with more ill-structured problems during clerkships. Such a transitional structure should particularly emphasise a developed repertoire of problem representations, recognition of key findings and a hierarchical classification of working hypotheses. It should foster the creation of links between the acquired basic clinical knowledge and the diagnostic, management and therapy steps of problem solving.

A Collaborative Project to Bridging the Gap between Basic and Clinical Teachers: The Opinion of Medical Students

“…Nevertheless, data were consistent across the years and reinforced the interest of following this educational approach. Additionally, the absence of control students who did not participate in the new subject prevented a proper evaluation of the influence of the subject matter in the progression of student confidence for some features of clinical reasoning, as has happened in other studies [21]. Nevertheless, our data allow for getting information about student needs and improvement on critical issues and may help to establish better training and teaching during the clinical years.…”

“…We also have some experience in this possibility, which we started with our students four years ago with positive results that have been described elsewhere [10]. The third one, the introduction of specific activities, is also an interesting experience that merits further exploration, and some examples can also be found in the medical literature [21]. In fact, the use of clinical scenarios has been recommended to introduce basic science concepts and to permit medical students to have a better understanding [22].…”

“…In fact, it has been widely shown that the case-based approach effectively promotes integration among basic, clinical, and social sciences and that clinical contexts, such as those used in Integrated Medicine, may be fundamental to successful integration [16,[26][27][28]. It has been stated that the progress from basic sciences to clinical years may require that students shift the processes of understanding and explain clinical findings in terms of basic sciences to those acquiring and interpreting clinical findings in order to diagnose and manage patient problems [21]. We believe that the logic of clinical medicine may be initially improved in the early years with the integrated approach, and the way to clinical thinking should be smoothed out as the continuity between basic knowledge and clinical clerkships is minimally assured [29].…”

O processo de ensino e aprendizagem do raciocínio clínico pelos estudantes de medicina da Universidade Estadual de Londrina

“…Em relação ao contexto de aprendizado, um grupo de estudiosos 32 sugere que deveria ser ministrado um curso para oportunizar o processo de raciocínio clínico com o emprego de problemas específicos e exemplos, antes de encontrar pacientes reais, pois as dificuldades percebidas pelos estudantes, em sua pesquisa, residiam em como conseguir os dados, interpretar e escolher os mais relevantes, sintetizar a informação e organizá-la hierarquicamente. Concordamos em que este tipo de estratégia pode minimizar a insegurança do estudante em seu processo de aprendizagem.…”

Social Constructivism and Case-Writing for an Integrated Curriculum

“…Results of several studies (Colsoun & Osborne, 1984;Dolmans, Gijselaers, Schmidt, & van der Meer, 1993;O'Neill, 2000;Van Gessel, Nendaz, Vermeulen, Junod, & Vu, 2003) have found a mismatch between learning issues generated by students and those developed by faculty, with only 60-64% of student learning issues, on average, corresponding to those generated by faculty during problem construction. Dolmans et al (1993) argue that this asymmetry may be due to poor problem design.…”