Using Group History-Taking and Individual Reasoning to Identify Shortcomings in Clinical Reasoning for Medical Students

Abstract

OBJECTIVE It is crucial that teaching faculties determine and remain informed of medical school learners’ clinical reasoning competence. We created an innovative assessment method for fourth-year medical students to identify deficiencies in various components of their clinical reasoning ability. METHODS This was a cross-sectional observational study of fourth-year medical students’ reasoning assessments from 2019 to 2022. Teams of four–five trainees questioned standardized patients in clinical scenarios, including fever, abdominal pain, and weight loss. They then individually documented key information to reflect comprehension of patient problems. Trainees were tasked with differentiating diagnoses and associated statuses and reaching the most likely diagnosis along with two tentative diagnoses. The correlations observed between 2020 and 2022 for abdominal pain were analyzed using student t -tests. RESULTS A total of 177 students participated in this study. Across the scenarios, there was no significant difference in key information representation scores (56%–58%). Reasoning ability scores were 49% for fever, 57% for abdominal pain, and 61% for weight loss. A comparison between 2020 and 2022 revealed a significant improvement in the objective structured clinical examination scores and differential diagnoses ( P < .01). Shortcomings included brief chief complaint duration, lack of detailed presentation, and insufficient description of negative information. Differential diagnosis and diagnostic justification were inadequate for acute and chronic conditions, and disease location clarity within the organ system was lacking. On average, students presented two correct diagnoses. CONCLUSIONS Fourth-year medical students exhibited inadequate reasoning abilities, particularly in fever and abdominal pain scenarios, with deficiencies in hypothesis generation and differential diagnosis. Group history-taking with individual reasoning assessment identified students’ shortcomings and provided faculty feedback to improve their teaching strategies.