Anuradha . Madhavan,Geisel School of Medicine at Dartmouth,Hanover,NH,Roshini Pinto-Powell,Geisel School of Medicine at Dartmouth,Hanover,NH,Adam Weinstein,Geisel School of Medicine at Dartmouth,Hanover,NH
Medical students must demonstrate proficiency in clinical knowledge across organ systems and translate that into clinical decision making. Clinical reasoning is a fundamental but challenging skill for the novice student to master.
We assess if a clinical reasoning curriculum in our pre-clinical On-Doctoring course improves student clinical reasoning skills in their pediatric clerkship.
Student performance improved from 2013 to 2015-2016 across all assessed measures (p<0.001 Chi-square, df = 33.22, 12). Students exceeding expectations increased from 7/16 (44%) to 14/28 (50%) for problem list generation, 1/16 (6%) to 12/37 (32%) for differential diagnosis formation, 7/17 (41%) to 25/37 (68%) for differential diagnosis prioritization, 3/17 (18%) to 14/34 (41%) for summary statement formation, and 4/16 (25%) to 15/35 (43%) for clinical management decisions. These improvements were similar for and there were no significant differences between outpatient and inpatient settings.
Our clinical reasoning curriculum has significantly improved pediatric clerkship student performance in multiple domains of clinical reasoning. We plan to assess how this curriculum has improved these skills in other clerkships.