The need for longitudinal clinical reasoning teaching and assessment: Results of an international survey

Abstract

Background: Clinical reasoning is a key ability essential for practising health professionals. However, little is known about the current global adoption of clinical reasoning teaching and assessment.

Purpose: We aimed to provide insights into how clinical reasoning is deliberately taught and assessed in curricula worldwide and to identify needs and perceived barriers for teaching clinical reasoning to students and educators.

Methods: A questionnaire was devised by an international expert group and distributed in a large international medical education community. Data were collected in 2018 and analysed using descriptive statistics. We identified themes in free-text responses using content analysis.

Results: Three hundred and thirteen responses from 76 countries were collected. Most respondents were from Europe (34%). While the presence of a longitudinal clinical reasoning curriculum was only reported by 28%, 85% stated that such a curriculum was needed. The lack of awareness of the need to explicitly teach clinical reasoning was the most commonly identified barrier. For assessment, the greatest need identified was for more workplace-based assessment.

Conclusions: Global respondents indicate the need to implement explicit longitudinal clinical reasoning curricula. Our findings suggest that efforts should be put into improving faculty development, including evidence-based materials on how to teach and assess clinical reasoning.

Keywords:

• Clinical reasoning education
• survey
• curriculum planning
• workplace-based assessment
• faculty development

Acknowledgements

The authors would like to thank for the generous assistance of Professor Ron Harden and Ms. Pat Lilley for sharing the mailing list for the present research. The authors thank their colleagues who participated in piloting of the questionnaire and those who freely gave their time in order to participate in the survey.

Disclosure statement

The authors report no conflicts of interest. The views expressed herein are those of the authors and not necessarily those of the U.S. Department of Defense or other federal agencies.

Additional information

Notes on contributors

Andrzej A. Kononowicz

Andrzej A. Kononowicz, MSc, PhD, is an associate professor at the Jagiellonian University Medical College in Kraków, Poland. His research focuses on technology-enhanced learning (including virtual patients) and clinical decision support systems.

Inga Hege

Inga Hege, MD, MCompSc, is an associate professor for medical education at the University of Augsburg in Germany.

Samuel Edelbring

Samuel Edelbring, PhD, is an associate professor heading a research group in health professions education. Key research topics are interprofessional learning and clinical reasoning.

Monika Sobocan

Monika Sobocan, MD, is the coordinator of the Centre for Medical Education at the Faculty of Medicine, University of Maribor, Slovenia. She is working as a physician in Obstetrics and Gynecology at the University Medical Center Maribor.

Sören Huwendiek

Sören Huwendiek, MD, PhD, MME, is an associate professor heading the Department for Assessment and Evaluation at the Institute for Medical Education in Bern, Switzerland. He is a paediatrician. His research focuses on formative assessment (including Virtual Patients and workplace-based assessments), summative assessment, blended learning, problem-based learning, and medical educators.

Steven J. Durning

Steven J. Durning, MD, PhD, is a professor of medicine and director of graduate programs in health professions education, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.