Strategies for developing pre-clinical medical students’ clinical reasoning based on illness script formation: a systematic review
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Clinical reasoning training in the pre-clinical phase has recently been considered important; however, when it comes to specific instructional methods for pre-clinical students, much is unknown. Thus, the aim of this review is to explore learning and teaching methods for pre-clinical students’ clinical reasoning development based on illness script formation, their results, and strategies. A systematic review was conducted in accordance with the guidelines of the Association for Medical Education in Europe. The literature search was performed using the Cochrane Library, PubMed, EMBASE, Web of Science, and ERIC databases based on keywords, including “illness script*” AND (“medical student*” OR pre-clinical OR undergraduate). Then, 10 studies among the 91 studies were included in the final analysis. The quality of the selected studies was also appraised using the Medical Education Research Study Quality Instrument. Diverse teaching and learning methods were used to support the integration of biomedical and clinical knowledge working with patient cases, and their effects were assessed through diverse methods, including illness script richness and maturity, to learner responses. The effects of these interventions were effective in terms of the clinical reasoning development of pre-clinical students. Learning and teaching strategies were synthesized and described. This review found that explicit attempts to promote illness script formation with a structured program rather than informal training lead to positive results, and such formal clinical reasoning programs can provide smooth transition from pre-clinical to clinical experience.
Abstract
Clinical reasoning training in the pre-clinical phase has recently been considered important; however, when it comes to specific instructional methods for pre-clinical students, much is unknown. Thus, the aim of this review is to explore learning and teaching methods for pre-clinical students’ clinical reasoning development based on illness script formation, their results, and strategies. A systematic review was conducted in accordance with the guidelines of the Association for Medical Education in Europe. The literature search was performed using the Cochrane Library, PubMed, EMBASE, Web of Science, and ERIC databases based on keywords, including “illness script*” AND (“medical student*” OR pre-clinical OR undergraduate). Then, 10 studies among the 91 studies were included in the final analysis. The quality of the selected studies was also appraised using the Medical Education Research Study Quality Instrument. Diverse teaching and learning methods were used to support the integration of biomedical and clinical knowledge working with patient cases, and their effects were assessed through diverse methods, including illness script richness and maturity, to learner responses. The effects of these interventions were effective in terms of the clinical reasoning development of pre-clinical students. Learning and teaching strategies were synthesized and described. This review found that explicit attempts to promote illness script formation with a structured program rather than informal training lead to positive results, and such formal clinical reasoning programs can provide smooth transition from pre-clinical to clinical experience.
참고문헌 (31)
- Levin M, "Teaching clinical reasoning to medical students : a case-based illness script worksheet approach", MedEdPORTAL, 12, pp.10445~ (2016)
- Norman G, "Research in clinical reasoning : past history and current trends", Med Educ, 39(4), pp.418~427 (2005)
- Schmidt HG, "How to improve the teaching of clinical reasoning : a narrative review and a proposal", Med Educ, 49(10), pp.961~973 (2015)
- Blunk DI, "Evaluating medical students’ clinical reasoning in psychiatry using clinical and basic science concepts presented in session-level integration sessions", Med Sci Educ, 29(3), pp.819~824 (2019)
- Xu H, "Methods to improve diagnostic reasoning in undergraduate medical education in the clinical setting : a systematic review", J Gen Intern Med, 36(9), pp.2745~2754 (2021)
- Charlin B, "Scripts and clinical reasoning", Med Educ, 41(12), pp.1178~1184 (2007)
- Pinnock R, "Identifying developmental features in students’ clinical reasoning to inform teaching", Med Teach, 41(3), pp.297~302 (2019)
- Eva KW, "What every teacher needs to know about clinical reasoning", Med Educ, 39(1), pp.98~106 (2005)
- Custers EJ, "The influence of medical expertise, case typicality, and illness script component on case processing and disease probability estimates", Mem Cognit, 24(3), pp.384~399 (1996)
- Keemink Y, "Illness script development in pre-clinical education through case-based clinical reasoning training", Int J Med Educ, 9, pp.35~41 (2018)
- Lubarsky S, "Using script theory to cultivate illness script formation and clinical reasoning in health professions education", Can Med Educ J, 6(2), pp.e61~e70 (2015)
- Barrows HS, "The clinical reasoning process", Med Educ, 21(2), pp.86~91 (1987)
- McLaughlin K, "Experttype knowledge structure in medical students is associated with increased odds of diagnostic success", Teach Learn Med, 19(1), pp.35~41 (2007)
- Young JQ, "Influence of learner knowledge and case complexity on handover accuracy and cognitive load : results from a simulation study", Med Educ, 50(9), pp.969~978 (2016)
- van Schaik P, "Influence of illness script components and medical practice on medical decision making", J Exp Psychol Appl, 11(3), pp.187~199 (2005)
- Schmidt HG, "How expertise develops in medicine : knowledge encapsulation and illness script formation", Med Educ, 41(12), pp.1133~1139 (2007)
- Woloschuk W, "Use of scheme-based problem solving : an evaluation of the implementation and utilization of schemes in a clinical presentation curriculum", Med Educ, 34, pp.437~442 (2000)
- Lee A, "Using illness scripts to teach clinical reasoning skills to medical students", Fam Med, 42(4), pp.255~261 (2010)
- Cooper N, "Consensus statement on the content of clinical reasoning curricula in undergraduate medical education", Med Teach, 43(2), pp.152~159 (2021)
- Sharma R, "Systematic reviews in medical education : a practical approach : AMEE guide 94", Med Teach, 37(2), pp.108~124 (2015)
- Reed DA, "Association between funding and quality of published medical education research", JAMA, 298(9), pp.1002~1009 (2007)
- Hennrikus EF, "Applying metacognition through patient encounters and illness scripts to create a conceptual framework for basic science integration, storage, and retrieval", J Med Educ Curric Dev, 5, pp.2382120518777770~ (2018)
- Moghadami M, "Teaching clinical reasoning to undergraduate medical students by illness script method : a randomized controlled trial", BMC Med Educ, 21(1), pp.87~ (2021)
- Peixoto JM, "The effect of self-explanation of pathophysiological mechanisms of diseases on medical students’ diagnostic performance", Adv Health Sci Educ Theory Pract, 22(5), pp.1183~1197 (2017)
- Royan R, "Anything but Shadowing! : early clinical reasoning in emergency department improves clinical skills", West J Emerg Med, 19(1), pp.177~184 (2018)
- Jackson JM, "The simulated virology clinic : a standardized patient exercise for preclinical medical students supporting basic and clinical science integration", MedEdPORTAL, 16, pp.10957~ (2020)
- Boshuizen HP, "What and how advanced medical students learn from reasoning through multiple cases", Instr Sci, 40(5), pp.755~768 (2012)
- Rumelhart DE, "Semantic Factors in Cognition", pp.37~53 (1978), University of California Press
- Sweller J, "Measuring cognitive load", Perspect Med Educ, 7(1), pp.1~2 (2018)
- Chamberland M, "Self-explanation in learning clinical reasoning : the added value of examples and prompts", Med Educ, 49(2), pp.193~202 (2015)
- Stark R, "Case-based learning with worked examples in complex domains : two experimental studies in undergraduate medical education", Learn Instr, 21(1), pp.22~33 (2011)