How Is Clinical Reasoning Developed, Maintained, and Objectively Assessed? Views from Expert Internists and Internal Medicine Interns1. Issue 4 (September 2013)

• Record Type: Journal Article
• Authors: Durning, Steven J.; Ratcliffe, Temple; Artino, Anthony R.; Vleuten, Cees; Beckman, Thomas J.; Holmboe, Eric; Lipner, Rebecca S.; Schuwirth, Lambert
• Is Part Of: Journal of continuing education in the health professions. Volume 33:Issue 4(2014:Autumn)
• Page Start: 215
• Page End: 223
• Publication Date: 2013-09
• Subjects: Medicine -- Study and teaching (Continuing education) -- Periodicals; Paramedical education -- Periodicals; Medical education -- Periodicals; 610.7
• DOI: 10.1002/chp.21188
• Languages: English
• ISSNs: 0894-1912

Abstract

<abstract abstract-type="main" xml:lang="en"> <title>Abstract</title> <sec id="abs1-1" sec-type="section"> <title>Introduction</title> <p>There is limited understanding of how clinical reasoning is developed, maintained, and objectively assessed. Using the theoretical lens of deliberate practice, we explored physicians' views on clinical reasoning. We compared responses from internists (faculty) and internal medicine interns, to identify potential qualitative and/or quantitative differences in how clinical reasoning is developed and maintained.</p> </sec> <sec id="abs1-2" sec-type="section"> <title>Methods</title> <p>Participants' free‐text comments regarding how clinical reasoning is developed, maintained, and objectively assessed were analyzed. Three investigators coded responses using a constant‐comparative, grounded theory approach. We also compared the frequencies of each theme between the 2 groups.</p> </sec> <sec id="abs1-3" sec-type="section"> <title>Results</title> <p>Twenty‐two faculty and 17 interns participated in this study. Faculty and intern themes for how clinical reasoning is developed, maintained, and objectively assessed were similar, but quantitative and qualitative differences emerged. Interrater reliability of themes was high (overall kappa: 0.92; range: 0.88–0.98). Only experts (faculty) mentioned the value of teaching for development and maintenance of clinical reasoning. Interns focused on knowledge acquisition activities and use of online resources. Experts and intern participants both struggled with how to best measure clinical reasoning; direct observation was rarely mentioned as a strategy.</p> </sec> <sec id="abs1-4" sec-type="section"> <title>Discussion</title> <p>Consistent with our theoretical expectations, we found quantitative and qualitative differences in participants' responses, which have implications for teaching and assessment of clinical reasoning. By capturing the types of activities and their relative frequencies within and between these groups, this work adds to the deliberate practice literature.</p> </sec> </abstract>