Development of clinical reasoning from the basic sciences to the clerkships: a longitudinal assessment of medical students' needs and self-perception after a transitional learning unit

Background  To facilitate students' transition from basic, science‐oriented, problem‐based learning (PBL) to clinical reasoning‐oriented PBL, the University of Geneva School of Medicine introduced a 12‐week unit of Introduction to Clinical Reasoning (ICR) at the beginning of its fourth or clerk...

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Bibliographic Details
Published in:Medical education 2003-11, Vol.37 (11), p.966-974
Main Authors: Van Gessel, Elisabeth, Nendaz, Mathieu R, Vermeulen, Bernard, Junod, Alain, Vu, Nu V
Format: Article
Language:English
Subjects:
Clinical Clerkship - standards
clinical clerkships/standards
clinical competence
Clinical Competence - standards
Curriculum
education
Education and psychology
Education, Medical, Undergraduate - methods
educational measurement
Educational sciences
Humans
Learning
Longitudinal Studies
medical
Problem Solving
Problem-Based Learning - methods
Psychology and learning
Science - education
Surveys and Questionnaires
Switzerland
undergraduate/methods
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Summary:Background  To facilitate students' transition from basic, science‐oriented, problem‐based learning (PBL) to clinical reasoning‐oriented PBL, the University of Geneva School of Medicine introduced a 12‐week unit of Introduction to Clinical Reasoning (ICR) at the beginning of its fourth or clerkship year. Purpose  The aims of the present study were to determine, after 12 weeks in the ICR unit, to what extent students had: (1) identified the learning content set by the faculty while adapting to the hypothetico‐deductive reasoning approach; (2) familiarised themselves with the clinical reasoning‐oriented learning process, and (3) transferred and further developed this process during the clinical years. Method  Students' derived objectives from the problems were compared to the objectives preset by the faculty to determine acquisition of intended learning content. To assess their adaptation to the clinical reasoning‐oriented PBL approach, students (n = 124) were asked to list and freely comment on aspects of the unit they felt most at ease with or had difficulty with, and to complete a questionnaire on the clinical reasoning process (CRP). The same questionnaire was administered 6 and 12 months later to assess the evolution of the students' self‐perception during clerkships. Results  On average, student objectives matched 62% of faculty objectives. Half of the missed (38%) objectives were in basic sciences. Students generated 16% additional objectives, also predominantly in the basic sciences category (41%). Free comments indicated that the difficulties perceived by students were very similar to those previously reported in studies on reasoning and errors, such as difficulty in gathering, interpreting and weighting relevant data, synthesising information, and organising it hierarchically. These results were confirmed with the CRP questionnaire administered at the end of the unit. For most of the competencies assessed on the CRP questionnaire, a gradual improvement was seen to have occurred by 6 and 12 months after the unit. Conclusions  To ease students' transition from the preclinical to clinical years, a learning unit should give them the opportunity to train their clinical reasoning processes on standardised and prototypical problems, before encountering real patients with more ill‐structured problems during clerkships. Such a transitional structure should particularly emphasise a developed repertoire of problem representations, recognition of key findings
ISSN:0308-0110
1365-2923
DOI:10.1046/j.1365-2923.2003.01672.x