Promoting medical student’s clinical reasoning during COVID-19 pandemic
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Purpose: The development of students’ clinical reasoning skills should be a consideration in the design of instruction and evaluation in medical education. In response to the coronavirus disease 2019 (COVID-19) pandemic, several changes in the medical curriculum have been implemented in promoting clinical reasoning. This study aims to explore medical students’ perceptions and experiences with the clinical reasoning curriculum during the COVID-19 pandemic and determine their skills development. Methods: The study used a mixed-method design with a concurrent approach. A cross-sectional study was conducted to compare and examine the relationship between the outcomes of the structured oral examination (SOE) and the Diagnostic Thinking Inventory (DTI). Then, the qualitative method was used. A focus group discussion using a semi-structured interview guide with open-ended questions was conducted, then the verbatim transcript was subjected to thematic analysis. Results: There is an increase in SOE and DTI scores between second-year to fourth-year students. The diagnostic thinking domains and SOE are significantly correlated (r=0.302, 0.313, and 0.241 with p<0.05). The three primary themes from the qualitative analysis are perceptions regarding clinical reasoning, clinical reasoning activities, and the learning component. Conclusion: Even if students are still studying throughout the COVID-19 pandemic, their clinical reasoning skills can improve. The clinical reasoning and diagnostic thinking skills of medical students increase as the length of the school year increases. Online case-based learning and assessment support the development of clinical reasoning skills. The skills are supported in their development by positive attitudes toward faculty, peers, case type, and prior knowledge.
Abstract
Purpose: The development of students’ clinical reasoning skills should be a consideration in the design of instruction and evaluation in medical education. In response to the coronavirus disease 2019 (COVID-19) pandemic, several changes in the medical curriculum have been implemented in promoting clinical reasoning. This study aims to explore medical students’ perceptions and experiences with the clinical reasoning curriculum during the COVID-19 pandemic and determine their skills development. Methods: The study used a mixed-method design with a concurrent approach. A cross-sectional study was conducted to compare and examine the relationship between the outcomes of the structured oral examination (SOE) and the Diagnostic Thinking Inventory (DTI). Then, the qualitative method was used. A focus group discussion using a semi-structured interview guide with open-ended questions was conducted, then the verbatim transcript was subjected to thematic analysis. Results: There is an increase in SOE and DTI scores between second-year to fourth-year students. The diagnostic thinking domains and SOE are significantly correlated (r=0.302, 0.313, and 0.241 with p<0.05). The three primary themes from the qualitative analysis are perceptions regarding clinical reasoning, clinical reasoning activities, and the learning component. Conclusion: Even if students are still studying throughout the COVID-19 pandemic, their clinical reasoning skills can improve. The clinical reasoning and diagnostic thinking skills of medical students increase as the length of the school year increases. Online case-based learning and assessment support the development of clinical reasoning skills. The skills are supported in their development by positive attitudes toward faculty, peers, case type, and prior knowledge.
참고문헌 (28)
- Gruppen LD, "Clinical reasoning : defining it, teaching it, assessing it, studying it", West J Emerg Med, 18(1), pp.4~7 (2017)
- Young M, "Drawing boundaries : the difficulty in defining clinical reasoning", Acad Med, 93(7), pp.990~995 (2018)
- Kassirer JP, "Teaching clinical reasoning : case-based and coached", Acad Med, 85(7), pp.1118~1124 (2010)
- Patel VL, "The Oxford Handbook of Thinking and Reasoning", pp.736~754 (2012), Oxford University Press
- Vidyarthi AR, "Factors associated with medical student clinical reasoning and evidence based medicine practice", Int J Med Educ, 6, pp.142~148 (2015)
- Levin M, "Teaching clinical reasoning to medical students : a case-based illness script worksheet approach", MedEdPORTAL, 12, pp.10445~ (2016)
- Yamauchi K, "Using peer role-playing to improve students’ clinical skills for musculoskeletal physical examinations", BMC Med Educ, 21(1), pp.322~ (2021)
- Audétat MC, "Diagnosis and management of clinical reasoning difficulties : Part I. Clinical reasoning supervision and educational diagnosis", Med Teach, 39(8), pp.792~796 (2017)
- Daniel M, "Clinical reasoning assessment methods : a scoping review and practical guidance", Acad Med, 94(6), pp.902~912 (2019)
- Gay S, "Teaching clinical reasoning to medical students", Clin Teach, 10(5), pp.308~312 (2013)
- Schmidt HG, "How to improve the teaching of clinical reasoning : a narrative review and a proposal", Med Educ, 49(10), pp.961~973 (2015)
- Bordage G, "Quantitative assessment of diagnostic ability", Med Educ, 24(5), pp.413~425 (1990)
- ten Cate O, "Principles and practice of case-based clinical reasoning education: a method for preclinical students" (2018), Springer Nature
- Caldwell KE, "Standardized oral examinations allow for assessment of medical student clinical knowledge and decrease racial grading differences in a surgery clerkship", Surgery, 171(3), pp.590~597 (2022)
- Keshmiri F, "Assessment of clinical reasoning and diagnostic thinking among dental students", Res Sq (2021)[DOI]
- Amey L, "Teaching clinical reasoning to medical students", Br J Hosp Med(Lond), 78(7), pp.399~401 (2017)
- Pinnock R, "Identifying developmental features in students’ clinical reasoning to inform teaching", Med Teach, 41(3), pp.297~302 (2019)
- Kiesewetter J, "Learning clinical reasoning : how virtual patient case format and prior knowledge interact", BMC Med Educ, 20(1), pp.73~ (2020)
- Bowen JL, "Now you see it, now you don’t : what thinking aloud tells us about clinical reasoning", J Grad Med Educ, 6(4), pp.783~785 (2014)
- Pinnock R, "Can think aloud be used to teach and assess clinical reasoning in graduate medical education?", J Grad Med Educ, 7(3), pp.334~337 (2015)
- Hussein Mohamed E, "Seeking autonomy : grounded theory of clinical reasoning processes during simulation based experiences", Nurse Educ Pract, 63, pp.103408~ (2022)
- Sutherland RM, "Assessing diagnostic reasoning using a standardized case-based discussion", J Med Educ Curric Dev, 6, pp.2382120519849411~ (2019)
- Schuwirth LW, "How ‘testing’ has become ‘programmatic assessment for learning’", Health Prof Educ, 5(3), pp.177~184 (2019)
- Mamede S, "Breaking down automaticity : case ambiguity and the shift to reflective approaches in clinical reasoning", Med Educ, 41(12), pp.1185~1192 (2007)
- Norman GR, "The causes of errors in clinical reasoning : cognitive biases, knowledge deficits, and dual process thinking", Acad Med, 92(1), pp.23~30 (2017)
- Jackson JM, "Medical students’clinical reasoning during a simulated viral pandemic : evidence of cognitive integration and insights on novices’approach to diagnostic reasoning", Med Sci Educ, 30(2), pp.767~774 (2020)
- Audétat MC, "Clinical reasoning difficulties : a taxonomy for clinical teachers", Med Teach, 35(3), pp.e984~e989 (2013)
- Beullens J, "Diagnostic ability in relation to clinical seminars and extended-matching questions examinations", Med Educ, 40(12), pp.1173~1179 (2006)