Council on Medical Student Education in Pediatrics


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Residents and Clinical Reasoning

Clinical Reasoning Tasks and Resident Physicians: What Do They Reason About? McBee E, Ratcliffe T, Goldszmidt M, Schuwirth L Picho K, Artino AR, Masel J, Durning SJ. Acad Med. 2016;91:1022–1028.

Reviewed by Fatima Aly

Tags: GME, clinical reasoning, reflection

What was the study question?
Given a straightforward clinical encounter, (1) what clinical reasoning tasks do internal medicine residents use and at what frequency and (2) does this occur in a sequential, linear and logical manner?

How was the study done?
Ten internal medicine residents from the National Capital and the San Antonio Uniformed Services Health Education Consortiums viewed three short videos of different clinical encounters with different psychosocial contexts. After each video, they completed a post-encounter form and then rewatched the video while using a think-aloud protocol with instructions to, at minimum, arrive at a diagnosis. Investigators then coded the verbal responses using a previously developed list of 24 clinical reasoning tasks.   They counted the number, type and order of tasks used.

What were the results?
The number and type of tasks used varied greatly between cases. The order in which the tasks were done was also highly variable and in a nonlinear but logical and purposeful manner. Participants most frequently addressed tasks related to framing the encounter and diagnosis rather than management or self-reflection.

What are the implications of the finding?
Clinical reasoning is dependent on the specific case context. Understanding the way that the use of clinical reasoning tasks vary by context may help educators reduce variability in ultimate diagnosis.

Editor’s Note: The authors don’t make much use of the fact that the participants were residents at different points in training. One would hope that use of these tasks differs as one becomes more seasoned. Time will tell. (JG)

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