The impact of a redesigned clinical course curriculum on the development of clinical reasoning skills among medical students: a quantitative study

Abstract

Background: Clinical reasoning is an essential skill for healthcare professionals to develop to better manage and treat their patients. It is best described as the ability to analyze, interpret, and investigate a patient appropriately given their constellation of symptoms and signs. Clinical reasoning has come under scrutiny as an area for professional development, with many questionings whether it can be formally taught or if it is simply an organic process which improves with experience. This study aims to investigate whether formalized clinical reasoning teaching during medical school has an impact on the clinical reasoning abilities of its students. Methods: Data was collected across three cohorts at the University of Nottingham Medical School. Each cohort had had varying degrees of clinical reasoning teaching, with Cohort 1 receiving no formalized clinical reasoning teaching, Cohort 2 receiving some teaching, and Cohort 3 having an embedded clinical reasoning component to their clinical education. The end of year exam results for each cohort were analyzed both in their first and final year of clinical exposure, to determine how well each cohort performed in the clinical reasoning component of the written tests. Results: On analysis of the results, the clinical reasoning scores were consistently higher in the cohort who received full clinical reasoning teaching during their clinical phases. There was one exception to this, but the data suggests this may itself be due to an anomaly in the overall abilities of that cohort during this time. With these results, the null hypothesis that clinical reasoning teaching has no significant effect on the clinical reasoning of students as measured by the clinical reasoning score in the summative exams was rejected. Conclusions: The main finding of this research was that the implementation of a clinical reasoning teaching curriculum can have a significant impact on the clinical reasoning of its students. This suggests that clinical reasoning can be developed both before and during clinical practice.