Clinical Reasoning and Improvement in the Quality of Medical Education

Abstract

Background: “Clinical reasoning" is the key skill in medical practice, and well beyond mere medical knowledge. However, regarding the current medical school curriculums, little attention has been paid to develop such skills. It might be the reason why diagnostic errors are still the major causes of the patients' harm.
Objectives: The purpose of this study was to investigate the effect of teaching clinical reasoning skills (problem-based training in small groups) on improvement of the clinical performance of medical interns.
Materials and Methods: This quasi-experimental study was conducted from September 2012 to September 2013. All of the interns entering the Pediatrics Department of Hamadan Medical Faculty (4 three-month courses) were enrolled. Courses were assigned alternately as intervention and control. Interns in the control group had conventional training but for intervention group, a clinical reasoning workshop was held in addition to the conventional education. To assess both groups, the Clinical Reasoning Problem (CRP) test was used as the pretest and posttest. Data were analyzed with t test and paired t test.
Results: Out of 62 participants, 30 (48%) were in the control group and 32 (52%) in the case group. Two groups were similar in baseline characteristics such as age and sex (P > 0.05). There was no significant difference between the scores of the two groups’ pretests (P > 0.05). The mean pretest and posttest scores of the control group had no significant difference (P > 0.05), but comparison of the mean pretest and posttest scores of case group represented significant difference (P < 0.05).
Conclusions: Clinical reasoning workshop will probably have a positive impact on upgrading clinical problem-solving skills.
Keywords: Medical Education; Problem Solving; Workshop