Methods to Improve Diagnostic Reasoning in Undergraduate Medical Education in the Clinical Setting: a Systematic Review

Abstract

BACKGROUND: In recent years, there have been numerous studies exploring different teaching methods for improving diagnostic reasoning in undergraduate medical students. This systematic review examines and summarizes the evidence for the effectiveness of these teaching methods during clinical training. METHODS: PubMed, Embase, Scopus, and ERIC were searched. The inclusion criteria for the review consist of articles describing (1) methods to enhance diagnostic reasoning, (2) in a clinical setting (3) on medical students. Articles describing original research using qualitative, quantitative, or mixed study designs and published within the last 10 years (1 April 2009-2019) were included. Results were screened and evaluated for eligibility. Relevant data were then extracted from the studies that met the inclusion criteria. RESULTS: Sixty-seven full-text articles were first identified. Seventeen articles were included in this review. There were 13 randomized controlled studies and four quasiexperimental studies. Of the randomized controlled studies, six discussed structured reflection, four self-explanation, and three prompts for generating differential diagnoses. Of the remaining four studies, two employed the SNAPPS 1 technique for case presentation. Two other studies explored schema-based instruction and using illness scripts. Twelve out of 17 studies reported improvement in clinical reasoning after the intervention. All studies ranked level two on the New World Kirkpatrick model. DISCUSSION: The authors posit a framework to teach diagnostic reasoning in the clinical setting. The framework targets specific deficiencies in the students' reasoning process. There remains a lack of studies comparing the effectiveness of different methods. More comparative studies with standardized assessment and evaluation of longterm effectiveness of these methods are recommended.

Strategies for developing pre-clinical medical students’ clinical reasoning based on illness script formation: a systematic review

“…Timely and detailed feedback from the faculty is one of the most important strategies in developing clinical reasoning skills [ 1 , 5 , 23 , 25 , 27 ]. Feedback is regarded as effective in promoting reflective processes and enhancing learning [ 31 ].…”

“…Clinical reasoning training in the pre-clinical phase has recently been considered important. Instead of informal experiential learning with varying quality of supervision during clinical clerkships [ 5 ], the need for more structured explicit attempts to teach clinical reasoning before clinical rotations is rising. Medical schools want to address this issue by designing a clinical reasoning program for pre-clinical students [ 6 , 7 ], but it poses challenges as the best way to develop clinical reasoning is uncertain.…”

“…Research regarding clinical reasoning development by focusing on illness script formation has recently been rising, but they have mostly targeted medical students during their clinical clerkships or above [ 6 , 7 , 18 ]. In addition, several systematic reviews have published methods to improve the clinical reasoning of undergraduate medical students [ 3 , 5 , 19 ], but none has been published regarding clinical reasoning development targeting pre-clinical medical students based on illness script formation. Thus, it is necessary and timely to conduct an in-depth analysis of such strategies to develop curriculum to foster preclinical medical students’ clinical reasoning based on illness script formation.…”

Comparison between residents with a 6-year medical program and a 7-year medical program in terms of objective structured clinical examination performance in postgraduate year training in Taiwan: a 2-group pre- and post-test non-synchronized study

“…Clinical reasoning has been recognized as a subject of science since the 1950s, and many medical educators are studying distinct ways to enhance clinical reasoning for medical students or junior physicians [ 12 ]. A systematic review published in 2021 reported that 12 of the 17 articles showed performance improvements among medical students after the intervention [ 13 ]. The teaching or learning styles included in these 12 articles included structured reflection, self-explanation, generating differential diagnoses, case presentation techniques, workshops with illness scripts, and schemas.…”

Scoping review: Diagnostic reasoning as a component of clinical reasoning in the U.S. primary care nurse practitioner education

“…advanced practice nursing, clinical reasoning, diagnosis, diagnostic reasoning, literature review, nurse practitioner, nurse practitioner education, nursing, nursing curriculum, scoping review diagnosis (Xu et al, 2021); appropriate and relevant diagnostic testing (Steiger et al, 2011); determining the working diagnosis (Charlin et al, 2007); developing an evidence-based and patientcentred management plan (Cooper et al, 2021); reflecting on one's DR competencies (Mamede et al, 2012;Olson et al, 2019).…”