Diagnosing and Remediating Clinical Reasoning Difficulties: A Faculty Development Workshop

Introduction Clinical reasoning is a complex cognitive process that involves multiple steps. Diagnosing and remediating clinical reasoning difficulties requires faculty to have an understanding of the cognitive theory behind clinical reasoning, familiarity with terminology, and a framework to identify different domains of struggle in their learners. Published resources on faculty development to diagnose and remediate clinical reasoning difficulties are limited. We created and implemented a workshop to assist faculty in developing these skills based on the five-domain framework described by Audétat, Laurin, and Sanche. This workshop provides all the materials needed to replicate this training with faculty at other institutions. Methods The workshop consists of a didactic component and case-based active learning in small groups. Each case focuses on different domains of clinical reasoning difficulties and targets different learner levels (preclinical medical students through residents). The workshop was given in multiple venues in 2016 and 2017. Results Participants reported the session was valuable (4.71/5.0), the facilitators were effective (4.5/5.0), and the objectives were met (4.28/5.0). They highlighted the strengths of the interactive format, the framework to diagnose and remediate clinical reasoning difficulties, and the excellent take-home resources. They suggested more time for the workshop, revision of cases to better highlight difficulties, and refinement of instructions to approach the cases. These suggestions were incorporated into the current iteration of the workshop. Discussion We successfully implemented a workshop for diagnosing and remediating clinical reasoning difficulties in multiple venues. The sessions were diverse in terms of faculty participants and learner groups addressed.

[1]  Roshini Pinto-Powell,et al.  Introductory Clinical Reasoning Curriculum , 2016 .

[2]  P. Croskerry When I say… cognitive debiasing , 2015, Medical education.

[3]  Pat Croskerry,et al.  From mindless to mindful practice--cognitive bias and clinical decision making. , 2013, The New England journal of medicine.

[4]  P. Croskerry The Importance of Cognitive Errors in Diagnosis and Strategies to Minimize Them , 2003, Academic medicine : journal of the Association of American Medical Colleges.

[5]  W. Cutrer,et al.  You Too Can Teach Clinical Reasoning! , 2012, Pediatrics.

[6]  N. McGlynn Thinking fast and slow. , 2014, Australian veterinary journal.

[7]  J. Bowen Educational strategies to promote clinical diagnostic reasoning. , 2006, The New England journal of medicine.

[8]  G. Norman Research in clinical reasoning: past history and current trends , 2005, Medical education.

[9]  Benji K. Mathews,et al.  Decision - Diagnosis: An Introduction to Diagnostic Error and Medical Decision-Making , 2016 .

[10]  S. Mamede,et al.  Cognitive debiasing 1: origins of bias and theory of debiasing , 2013, BMJ quality & safety.

[11]  Pat Croskerry,et al.  Cognitive debiasing 2: impediments to and strategies for change , 2013, BMJ quality & safety.

[12]  Bernard Charlin,et al.  An analysis of clinical reasoning through a recent and comprehensive approach: the dual-process theory , 2011, Medical education online.

[13]  G. Bordage Prototypes and semantic qualifiers: from past to present , 2007, Medical education.

[14]  Pat Croskerry,et al.  A universal model of diagnostic reasoning. , 2009, Academic medicine : journal of the Association of American Medical Colleges.

[15]  Bernard Charlin,et al.  Clinical reasoning difficulties: A taxonomy for clinical teachers , 2013, Medical teacher.