MedEdPORTAL (Mar 2016)
Introductory Clinical Reasoning Curriculum
Abstract
Abstract Introduction Clinical reasoning is a fundamental skill necessary to the practice of medicine. For the novice learner, it is a difficult skill to master and most teachers have a difficult time making the process of clinical reasoning explicit and evident. Based on student feedback, we conducted an extensive review of the topic, identifying key articles and workshops, and created a new clinical reasoning curriculum in the first- and second-year On Doctoring course at the Geisel School of Medicine at Dartmouth. Methods The curriculum includes a series of two clinical reasoning small-group (eight students) practice skills sessions in the spring for first-year medical students and five such sessions spread across the academic year for second-year medical students. We use a flipped classroom pedagogy in which students review preparatory materials prior to class to enhance case discussion and then practice clinical reasoning skills during class, including forming problem lists, summary statements using semantic qualifiers, differential diagnosis, and an assessment and plan for the case. The interactive skills session is facilitated by one or two faculty members. Results The curriculum was received favorably by students and facilitators. Faculty facilitators noted improvement in the assessment and plan portions of student case presentations and write-ups. Feedback from our students was positive, with over 90% of students identifying satisfaction with the sessions on their midyear course feedback and close to 80% of students on their year-end course feedback. We are evaluating whether it has resulted in augmented clinical reasoning skills in the third year of medical school. Discussion Published materials on introductory student clinical reasoning curricula are limited. Our curriculum serves as a model to introduce clinical reasoning to students prior to immersion in their clinical rotations.
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