Sharon E. Sholiton,Rush Medical College,Chicago,IL,Gina Lowell,Rush Medical College,Chicago,IL,Jean A. Petershack,University of Texas Health Sciences Center San Antonio,San Antonio,Texas,Soo Y. Kim,Loma Linda University,Loma Linda,CA
Background: Medical students require both practice and feedback to develop their clinical reasoning skills. CLIPP cases model aspects of clinical decision-making used in patient care, and are utilized by the majority of clerkship directors to augment student clinical experiences. The CLIPP CAT has been developed for use in conjunction with the CLIPP cases, as a tool to promote student clinical reasoning skills. This project was designed to capture student input regarding use of this tool as a method to develop students’ clinical reasoning skills.
Assess the ability of the CLIPP CAT to provide meaningful feedback to M3 students regarding their clinical reasoning skills.
Gather student input regarding use of the CAT to refine its use in clerkship education.
Methods: All M3 students at three sites (Rush, Loma Linda, UTHSCSA) used the CAT to analyze 4 CLIPP cases during their pediatric clerkship in AY 2013-14. These 4 cases were then reviewed with the group and students assessed their own work on the CAT. Students completed anonymous surveys to provide input about the educational value of this process. Six focus groups (2/per site) gathered student input re: use of the CAT. MedU provided funding for this project; an IRB was obtained at each site.
Results: Data from 469 student surveys has been analyzed. Mean scores regarding the ability of the CAT to facilitate meaningful feedback range from 3.72-3.92/5 on a 5 point Likert scale. Mean scores relating to skill development (identifying problem cues, formulating a problem statement, prioritizing a differential diagnosis, generating an evaluation/treatment plan) range from 3.64-3.76/5 on a 5 point Likert scale. Scores were higher from students during the first half of their M3 year. (p < .05). Focus group transcripts and student comments provided a rich source of information regarding student use of the CAT. Themes emerging through constant comparative analysis suggest that the CAT promotes clinical reasoning skill development and retention of information, though use requires significant investment of time and may be perceived as repetitious.
Discussion: This study demonstrates that the CLIPP CAT may facilitate meaningful feedback to students about their clinical reasoning skills, and may be a valuable adjunct to independent use of the CLIPP cases by students. Use of the CAT as described may be most beneficial to early M3 learners. Review of focus group transcripts indicates that students using the CAT engage in behaviors that reflect aspects of clinical reasoning, though requiring significant time investment. Further analysis may identify strategies for optimal use of the CAT to promote M3 skill development.