Identifying developmental features in students' clinical reasoning to inform teaching*. (4th March 2019) - Pinnock, Ralph
Abstract: Background: There is increasing evidence that students at different levels of training may benefit from different methods of learning clinical reasoning. Two of the common methods of teaching are the " whole – case " format and the " serial cue" approach. There is little empirical evidence to guide teachers as to which method to use and when to introduce them. Methods: We observed 23 students from different stages of training to examine how they were taking a history and how they were thinking whilst doing this. Each student interviewed a simulated patient who presented with a straightforward and a complex presentation. We inferred how students were reasoning from how they took a history and how they described their thinking while doing this. Results: Early in their training students can only take a generic history. Only later in training are they able to take a focused history, remember the information they have gathered, use it to seek further specific information, compare and contrast possibilities and analyze their data as they are collecting it. Conclusions: Early in their training students are unable to analyze data during history taking. When they have started developing illness scripts, they are able to benefit from the " serial cue" approach of teaching clinical reasoning.