An innovative approach to inculcate analytical and non-analytical clinical reasoning among medical students

Dear Sir

Clinical reasoning is a cognitive process by which clinicians diagnose illnesses and manage them and is considered as the primary determinant of clinical competence (Charlin et al. 2000). Over the past 15 years, research directed to better understand this complex, multifaceted skill has led to the consensus that clinicians generally use two types of approaches in clinical reasoning: analytical and non-analytical (Pelaccia et al. 2011). Non-analytical reasoning is a tacit, heuristic approach that is based on previous experience (Pelaccia et al. 2011). It matches a specific clinical presentation under consideration with previously encountered similar cues, signs and situations. The advantage of this type of reasoning is that it is effortless, quick and a decision is made at the subconscious level. By contrast, analytical reasoning is a rational assessment of the clinical problem based on in-depth analysis of potential causes. The decision is based on conscious application of rules that have been acquired through learning. The advantage of this type of reasoning is that the decision is made after consideration and elimination of several possible causes, thereby increasing the accuracy of diagnosis.

At the College of Medicine, Alfaisal University, we have developed an innovative approach which allows students to develop both heuristic and analytical reasoning using a case-based method of learning. In this approach, both students and the experienced clinical tutor will work as a group to solve a clinical case without prior knowledge of the diagnosis. Both students and tutors are presented with the clinical case and a complete medical record of it. The group works together to analyse the available information and reach a definitive diagnosis. During the process the tutor will share with the students his experiential reasoning regarding the case. After the correct diagnosis is revealed to the group they will discuss the clues which led them to the diagnosis and distractors which were misleading them. In this method since the tutors are unaware of the final diagnosis of the case, they are using their heuristic as well as analytical skills to solve the problems alongside students.

The approach of using experienced clinical tutors to work with novices to solve a clinical case is currently used successfully at Alfaisal. This represents an innovative case-based approach which inculcates both heuristic and analytical thinking.