Students’ educational needs for clinical reasoning in first clerkships

Developing clinical reasoning skills early in medical education is important. However, research to uncover students’ educational needs for learning clinical reasoning during clerkships is limited. The aim of our study was to investigate these needs. Focus group discussions with an independent moderator were conducted. Students were included directly after 10 weeks of clerkships. The (verbatim) transcripts were coded manually and discussed by the authors until consensus was reached. Saturation was reached after three focus groups, including 18 students in total. Statistical analysis indicated our sample matched the approached group of 61 students. After a consistency and redundancy check in ATLAS.ti, 79 codes could be identified. These could be grouped into seven key themes: (1) transition to the clinical phase, (2) teaching methods, (3) learning climate, (4) students’ motivation, (5) teacher, (6) patient and (7) strategies in clinical reasoning. Students can adequately describe their needs; of the seven key themes relevant to clinical reasoning five are in line with literature. The remaining two (patient factors and the need for strategy for clinical reasoning) have not been identified before.

[1]  Lambert Schuwirth,et al.  Can clinical reasoning be taught or can it only be learned? , 2002, Medical education.

[2]  K. Eva What every teacher needs to know about clinical reasoning , 2005, Medical education.

[3]  Sue Ziebland,et al.  Analysing qualitative data , 2000, BMJ : British Medical Journal.

[4]  H. Schmidt,et al.  A cognitive perspective on medical expertise: theory and implication [published erratum appears in Acad Med 1992 Apr;67(4):287] , 1990, Academic medicine : journal of the Association of American Medical Colleges.

[5]  Robert Dingwall,et al.  Catching Goldfish: Quality in Qualitative Research , 1998, Journal of health services research & policy.

[6]  Sofie M. M. Loyens,et al.  The Role of Biomedical Knowledge in Clinical Reasoning: A Lexical Decision Study , 2005, Academic medicine : journal of the Association of American Medical Colleges.

[7]  J. Kitzinger,et al.  Qualitative Research: Introducing focus groups , 1995 .

[8]  D. Morgan Focus groups for qualitative research. , 1988, Hospital guest relations report.

[9]  G. Bordage,et al.  Promoting diagnostic problem representation , 2002, Medical education.

[10]  N. Charness,et al.  Expert Performance Its Structure and Acquisition , 2002 .

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

[12]  Geoffrey Norman,et al.  Building on experience--the development of clinical reasoning. , 2006, The New England journal of medicine.

[13]  J. Knottnerus,et al.  Real world research. , 2010, Journal of clinical epidemiology.

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

[15]  G. Dhaliwal,et al.  Twelve tips for presenting a clinical problem solving exercise , 2009, Medical teacher.

[16]  A. Darzi,et al.  Simulation and clinical practice: strengthening the relationship , 2004, Medical education.

[17]  P. Harasym,et al.  Helping students learn to think like experts when solving clinical problems , 1997, Academic medicine : journal of the Association of American Medical Colleges.

[18]  R. Bloch,et al.  The role of strategy and redundancy in diagnostic reasoning , 2003, BMC medical education.

[19]  P. Thomas,et al.  Teaching medical students the important connection between communication and clinical reasoning , 2005, Journal of General Internal Medicine.

[20]  Yvonne Steinert,et al.  Student perceptions of effective small group teaching , 2004, Medical education.

[21]  B F Richards,et al.  How Medical Students and Residents Describe the Roles and Characteristics of Their Influential Clinical Teachers , 2000, Academic medicine : journal of the Association of American Medical Colleges.

[22]  P H Harasym,et al.  Diagnostic reasoning strategies and diagnostic success , 2003, Medical education.

[23]  E. Murphy,et al.  Qualitative research methods in health technology assessment: a review of the literature. , 1998, Health technology assessment.

[24]  D. Cook,et al.  Students’ perception of the characteristics of effective bedside teachers , 2007, Medical teacher.

[25]  Jan C C Borleffs,et al.  “Clinical Reasoning Theater”: A New Approach to Clinical Reasoning Education , 2003, Academic medicine : journal of the Association of American Medical Colleges.

[26]  H. Schmidt,et al.  A Cognitive Perspective on Medical Expertise: Theory and Implications , 1990 .

[27]  S. Ziebland,et al.  Analysing qualitative data , 2000, BMJ : British Medical Journal.

[28]  Lee Brooks,et al.  Non‐analytical models of clinical reasoning: the role of experience , 2007, Medical education.

[29]  R. Barbour Making sense of focus groups , 2005, Medical education.

[30]  J. Busari,et al.  Educating doctors in the clinical workplace: unraveling the process of teaching and learning in the medical resident as teacher. , 2009, Journal of postgraduate medicine.

[31]  A. Scherpbier,et al.  Residents' perceptions of the ideal clinical teacher--a qualitative study. , 2008, European journal of obstetrics, gynecology, and reproductive biology.

[32]  Hirotaka Onishi The Role of Case Presentation for Teaching and Learning Activities , 2008, The Kaohsiung journal of medical sciences.

[33]  A. Scherpbier,et al.  Attending doctors' perspectives on how residents learn , 2007, Medical education.

[34]  Nicole N Woods,et al.  The value of basic science in clinical diagnosis: creating coherence among signs and symptoms , 2005, Medical education.