Implementation of a Clinical Reasoning Course in the Internal Medicine trimester of the final year of undergraduate medical training and its effect on students' case presentation and differential diagnostic skills

Harendza, Sigrid; Krenz, Ingo; Klinge, Andreas; Wendt, Ulrike; Janneck, Matthias

doi:10.3205/zma001143

Cited by 15 publications

(7 citation statements)

References 26 publications

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“…The low performance self-assessment of ‘Scientifically and empirically grounded method of working’ could be due to a lack of clinical reasoning training in the undergraduate medical curricula [ 29 ]. More exercises in evidence-based medicine, which is a prerequisite for clinical decision making [ 30 , 31 ] as well as in clinical reasoning [ 32 ] could also improve medical graduates’ preparedness for residency, in which ‘Empathy and openness’, which was highly rated, must be combined with a ‘Scientifically and empirically grounded method of working’ [ 33 ].…”

Section: Discussionmentioning

confidence: 99%

Final-year medical students’ self-assessment of facets of competence for beginning residents

et al. 2022

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Background Final-year undergraduate medical students often do not feel well prepared for their start of residency training. Self-assessment of competences is important so that medical trainees can take responsibility for their learning. In this study, we investigated how final-year medical students self-assessed their competences as they neared their transition to postgraduate training. The aim was to identify areas for improvement in undergraduate training. Methods In the academic year 2019/2020, a national online survey was sent to final-year undergraduate medical students via their respective medical schools. The survey included ten facets of competence (FOC) most relevant for beginning residents. The participants were asked to self-assess their competence for each FOC on a 5-point Likert scale (1: strongly disagree to 5: strongly agree). We established an order of self-assessed FOC performance by means and calculated paired t-tests. Gender differences were assessed with independent t-tests. Results A total of 1083 students from 35 medical schools completed the questionnaire. Mean age was 27.2 ± 3.1 years and 65.8% were female. Students rated their performance highest in the FOCs ‘Teamwork and collegiality’ and ‘Empathy and openness’ (97.1 and 95.0% ‘strongly agree’ or ‘agree’, respectively) and lowest in ‘Verbal communication with colleagues and supervisors’ and ‘Scientifically and empirically grounded method of working’ (22.8 and 40.2% ‘strongly disagree’, ‘disagree’, or ‘neither agree nor disagree’, respectively). Women rated their performance of ‘Teamwork and collegiality’, ‘Empathy and openness’, and ‘Knowing and maintaining own personal bounds and possibilities’ significantly higher than men did (Cohen’s d > .2), while men showed higher self-assessed performance in ‘Scientifically and empirically grounded method of working’ than women (Cohen’s d = .38). The FOCs ‘Responsibility’, ‘Knowing and maintaining own personal bounds and possibilities’, ‘Structure, work planning, and priorities’, ‘Coping with mistakes’, and ‘Scientifically and empirically grounded method of working’ revealed lower self-assessed performance than the order of FOC relevance established by physicians for beginning residents. Conclusions The differences between the level of students’ self-assessed FOC performance and physicians’ ranking of FOC relevance revealed areas for improvement in undergraduate medical education related to health system sciences. Final-year students might benefit from additional or better training in management skills, professionalism, and evidence-based medicine. Surveys of self-assessed competences may be useful to monitor competence development during undergraduate training.

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Section: Discussionmentioning

confidence: 99%

Final-year medical students’ self-assessment of facets of competence for beginning residents

et al. 2022

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“…The patient cases, which were based on a chief complaint or finding, could only be solved by analytical reasoning and not by pattern recognition alone. 15 , 16 The chosen chief complaints or main medical findings and the patients' personal condition represented specific contextual challenges in the daily medical routine.…”

Section: Methodsmentioning

confidence: 99%

Frequency of medical students' language expressing implicit uncertainty in simulated handovers

et al. 2022

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Objectives:The aim of this study was to investigate the number and type of implicit expressions of uncertainty by medical students during simulated patient handovers. Methods: Eighty-seven volunteer medical students, a convenience sample collected on a first-come, first-served basis, participated in simulated handovers. They each worked with three simulated patients who presented with different chief complaints and personal conditions. The handovers were video recorded and transcribed. A framework of implicit expressions of uncertainty was used to identify and count modifiers that attenuate or strengthen medical information using MAXQDA lexical search. We analysed the findings with respect to the patients' contexts. Results: Implicit uncertainty expressions which attenuate or strengthen information occurred in almost equal frequency, 1879 (55%) versus 1505 (45%). Attenuators were found most frequently in the category 'Questionable', 1041 (55.4%), strengtheners in the category 'Focused', 1031 (68.5%). Most attenuators and strengtheners were found in the handover of two patients with challenging personal conditions ('angry man', 434 (23.1%) versus 323 (21.5%); 'unfocused woman', 354 (19.4%) versus 322 (21.4%)) and one patient with abnormal laboratory findings ('elevated creatinine', 379 (20.2%) versus 285 (18.9%)). Conclusions: Medical students use a variety of implicit expressions of uncertainty in simulated handovers. These findings provide an opportunity for medical educators to design communication courses that raise students' awareness for content-dependent implicit expressions of uncertainty and provide strategies to communicate uncertainty explicitly.

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“…Work-based assessments included clinical instructors' ratings of students' clinical skills performance, 21,46,48 mini clinical evaluation exercises, 5,37 and the Physical Therapist Clinical Performance Instrument. 48 Nonwork-based assessments included students' self-reported confidence in making clinical decisions in practical exams 46 ; self-reflections 21 ; self-reported CR skills 4 ; written assessments, such as the Script Concordance test, 20,37 the Key Feature approach, 5 the Diagnostic Thinking Inventory, 29,42 the Reasoning 4 Change instrument, 49 critical thinking tests, 20,47 and the National Council Licensure Examination for nurses 30 ; written case reports, 4,29,37 think-aloud techniques, 20,37,41,43 and observational tools used together with the case method. 35 Assessment in simulated environments included the use of virtual patients in which feedback, and self-and formative assessments were integrated, 33,37 and objective structured clinical examinations.…”

Section: Clinical Reasoning Theories Models and Framework That Inform...mentioning

confidence: 99%

“…The literature shows instead that CR is scarcely explicitly taught or assessed in health professions education programs. [4][5][6][7][8] Reasons for this scarcity could be CR's complexity, multidimensionality, and varying definitions within and across professions. 9 As CR in practice is not a straightforward single best route to arrive to a diagnosis or a management decision, CR teaching and learning implies consideration of ambiguity and a focus on the process, not only the outcome, which might be challenging to apply in nonclinical learning contexts.…”

Section: Introductionmentioning

confidence: 99%

Clinical Reasoning Curricula in Health Professions Education: A Scoping Review

Elvén,

Welin,

Wiegleb Edström

et al. 2023

Journal of Medical Education and Curricular Development

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OBJECTIVES This scoping review aimed to explore and synthesize current literature to advance the understanding of how to design clinical reasoning (CR) curricula for students in health professions education. METHODS Arksey and O’Malley's 6-stage framework was applied. Peer-reviewed articles were searched in PubMed, Web of Science, CINAHL, and manual searches, resulting in the identification of 2932 studies. RESULTS Twenty-six articles were included on CR in medical, nursing, physical therapy, occupational therapy, midwifery, dentistry, and speech language therapy education. The results describe: features of CR curriculum design; CR theories, models, and frameworks that inform curricula; and teaching content, methods, and assessments that inform CR curricula. CONCLUSIONS Several CR theories, teaching, and assessment methods are integrated into CR curricula, reflecting the multidimensionality of CR among professions. Specific CR elements are addressed in several curricula; however, no all-encompassing CR curriculum design has been identified. These findings offer useful insights for educators into how CR can be taught and assessed, but they also suggest the need for further guidance on educational strategies and assessments while learners progress through an educational program.

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Implementation of a Clinical Reasoning Course in the Internal Medicine trimester of the final year of undergraduate medical training and its effect on students' case presentation and differential diagnostic skills

Cited by 15 publications

References 26 publications

Final-year medical students’ self-assessment of facets of competence for beginning residents

Final-year medical students’ self-assessment of facets of competence for beginning residents

Frequency of medical students' language expressing implicit uncertainty in simulated handovers

Clinical Reasoning Curricula in Health Professions Education: A Scoping Review

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