Teaching clinical reasoning to undergraduate medical students by illness script method: a randomized controlled trial

Abstract

Background The illness script method employs a theoretical outline (e.g., epidemiology, pathophysiology, signs and symptoms, diagnostic tests, interventions) to clarify how clinicians organized medical knowledge for clinical reasoning in the diagnosis domain. We hypothesized that an educational intervention based on the illness script method would improve medical students’ clinical reasoning skills in the diagnosis domain. Methods This study is a randomized controlled trial involving 100 fourth-year medical students in Shiraz Medical School, Iran. Fifty students were randomized to the intervention group, who were taught clinical reasoning skills based on the illness script method for three diseases during one clinical scenario. Another 50 students were randomized to the control group, who were taught the clinical presentation based on signs and symptoms of the same three diseases as the intervention group. The outcomes of interest were learner satisfaction with the intervention and posttest scores on both an internally developed knowledge test and a Script Concordance Test (SCT). Results Of the hundred participating fourth-year medical students, 47 (47%) were male, and 53 (53%) were female. On the knowledge test, there was no difference in pretest scores between the intervention and control group, which suggested a similar baseline knowledge in both groups; however, posttest scores in the intervention group were (15.74 ± 2.47 out of 20) statistically significantly higher than the control group (14.38 ± 2.59 out of 20, P = 0.009). On the SCT, the mean score for the intervention group (6.12 ± 1.95 out of 10) was significantly higher than the control group (4.54 ± 1.56 out of 10; P = 0.0001). Learner satisfaction data indicated that the intervention was well-received by students. Conclusion Teaching with the illness script method was an effective way to improve students’ clinical reasoning skills in the diagnosis domain suggested by posttest and SCT scores for specific clinical scenarios. Whether this approach translates to improved generalized clinical reasoning skills in real clinical settings merits further study.

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

“…The strategies include three categories: learning and teaching settings, contents, and methods. First, regarding learning and teaching settings, five studies used small group settings to encourage the discussion among the group of students with their facilitators [ 1 , 4 , 10 , 23 , 26 ]. The focus of the programs for developing students’ illness scripts should be on tuning and restructuring previously acquired knowledge instead of acquiring new knowledge for use in clinical contexts [ 10 , 26 , 28 ].…”

“…A direct illness script teaching method that helps students develop correct problem representations and illness scripts is also useful in terms of the construction of pre-clinical students’ illness scripts [ 1 , 23 ]. This approach explicitly teaches illness script construction with an illness script worksheet.…”

“…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 ].…”

Ensino do Raciocínio Clínico Orientado pela Teoria dos Scripts de Doenças

“…Outros estudos se orientaram pela teoria dos SD, no entanto este é um dos primeiros a mimetizar os estágios do seu desenvolvimento. Moghadami et al, 12 compararam o ensino do RC, orientado pelos SD ao ensino tradicional em estudantes do 4º ano. O grupo intervenção, após a leitura de um caso clínico, foi orientado a identificar a RM do problema e comparar os componentes dos SD para 3 diagnósticos diferenciais, enquanto o grupo controle assistiu uma aula expositiva sobre as doenças do estudo e discutiram em pequenos grupos.…”

Prueba de concordancia de guiones para entrenar el razonamiento clínico en estudiantes de fonoaudiología

“…Esta habilidad es crucial para la toma de decisiones clínicas a fin de brindar tratamientos adecuados, requiriendo de conocimientos de base y habilidades cognitivas que exigen entrenamiento (Shin, 2019). Los educadores médicos coinciden en que el RC debe ser incorporado de forma explícita en los currículos de profesionales de la salud (Moghadami, Amini, Moghadami, Dalal y Charlin, 2021), aún en etapas preclínicas. Así mismo se ha descrito que la valoración del RC es una herramienta útil para la evaluación de competencias (Humbert, et al, 2011), considerando que es indispensable en todas las formas de atención sanitaria (Delany y Golding, 2014).…”