Identifying developmental features in students’ clinical reasoning to inform teaching*

Abstract

Background: There is increasing evidence that students at different levels of training may benefit from different methods of learning clinical reasoning. Two of the common methods of teaching are the “whole – case” format and the “serial cue” approach. There is little empirical evidence to guide teachers as to which method to use and when to introduce them.

Methods: We observed 23 students from different stages of training to examine how they were taking a history and how they were thinking whilst doing this. Each student interviewed a simulated patient who presented with a straightforward and a complex presentation. We inferred how students were reasoning from how they took a history and how they described their thinking while doing this.

Results: Early in their training students can only take a generic history. Only later in training are they able to take a focused history, remember the information they have gathered, use it to seek further specific information, compare and contrast possibilities and analyze their data as they are collecting it.

Conclusions: Early in their training students are unable to analyze data during history taking. When they have started developing illness scripts, they are able to benefit from the “serial cue” approach of teaching clinical reasoning.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.

Additional information

Funding

This work was funded by Department of Women’s and Children’s Health, Dunedin School of Medicine, New Zealand.

Notes on contributors

Ralph Pinnock

Ralph Pinnock, FRACP, MClin Ed, Associate Dean Medical Education, Head, Medical Education Unit, The Office of the Dean, Dunedin, New Zealand.

Megan Anakin

Megan Anakin, PhD(Otago), Medical education Adviser Medical Education Unit, The Office of the Dean, Dunedin, New Zealand.

Julie Lawrence

Julie Lawrence, PhD, Research Fellow, Department of Women’s and Children’s Health, University of Otago, Dunedin.

Helen Chignell

Helen Chignell, MBCh, Diploma in Sports Medicine Director of Clinical skills, Early Learning in Medicine, Dunedin School of Medicine, Dunedin, New Zealand.

Tim Wilkinson

Tim Wilkinson, MBChB, MD(Otago), PhD(Otago), MClin Ed(UNSW), FRACP, FRCP(London), FANZAHPE, Professor and Director, MB ChB program (Faculty of Medicine), University of Otago, Christchurch, New Zealand.