The Student-Generated Reasoning Tool (SGRT): Linking medical knowledge and clinical reasoning in preclinical education

Abstract

Introduction

The simultaneous integration of knowledge acquisition and development of clinical reasoning in preclinical medical education remains a challenge. To help address this challenge, the authors developed and implemented the Student-Generated Reasoning Tool (SGRT)—a tool asking students to propose and justify pathophysiological hypotheses, generate findings, and critically appraise information.

Methods

In 2019, students in a first-year preclinical course (n = 171; SGRT group) were assigned to one of 20 teams. Students used the SGRT individually, then in teams, and faculty provided feedback. The control group (n = 168) consisted of students from 2018 who did not use SGRT. Outcomes included academic performance, effectiveness of collaborative environments using the SGRT, and student feedback.

Results

Students were five times more likely to get questions correct if they were in the SGRT group versus control group. Accuracy of pathophysiological hypotheses was significantly lower for individuals than teams. Qualitative analysis indicated students benefited from generating their own data, justifying their reasoning, and working individually as well as in teams.

Conclusions

This study introduces the SGRT as a potentially engaging, case-based, and collaborative learning method that may help preclinical medical students become aware of their knowledge gaps and integrate their knowledge in basic and clinical sciences in the context of clinical reasoning.

Keywords:

• Undergraduate medical education
• clinical reasoning
• concordance
• team-based learning
• higher-order learning

Acknowledgements

The authors wish to thank the Harvard Medical School faculty in Homeostasis II who willingly agreed to participate and provide students feedback: Dr. Lauren G. Fiechtner, Dr. Alison H. Goldin, and Dr. David X. Jin. We would like to thank Dr. Amy M. Sullivan, associate professor of medicine at Harvard Medical School, who was an invaluable advisor concerning qualitative analysis. We also wish to thank Dr. Richard M. Schwartzstein, Ellen and Melvin Gordon Professor of Medicine and Medical Education at Harvard Medical School, for emphasizing the added value of justifications in the Student-Generated Reasoning Tool.

Disclosure statement

The authors report no conflicts of interest and received no funding for this study. IZ-O gave a presentation on the Student-Generated Reasoning Tool at the HMS Academy Medical Education Grand Rounds, Harvard Medical School, Boston, Massachusetts, March 25, 2020, and the AMEE Virtual Conference, Dundee, United Kingdom, September 7, 2020.

Additional information

Notes on contributors

Ivry Zagury-Orly

Ivry Zagury-Orly, BSc, MMSc, was, when this study occurred, a student in the Master’s in Medical Education Program, Harvard Medical School, Boston, Massachusetts, United States. He is currently a fourth-year medical student, Faculty of Medicine, Université de Montréal, Montreal, Quebec.

Daniel S. Kamin

Daniel S. Kamin, MD is a gastroenterologist and assistant professor of pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Boston, Massachusetts.

Edward Krupat

Edward Krupat, PhD, is associate professor of medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.

Bernard Charlin

Bernard Charlin, MD, PhD, is professor of surgery, Centre for Pedagogy Applied to the Health Sciences, Department of Surgery, Faculty of Medicine, Université de Montréal, Montreal, Quebec.

Nicolas Fernandez

Nicolas Fernandez, PhD, is associate professor, Centre for Pedagogy Applied to the Health Sciences, Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebec.

Krisztina Fischer

Krisztina Fischer, MD, PhD, MMSc, is assistant professor of radiology, Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts.