Jacqueline M I Torti, Susan Humphrey Murto, Kristen A Bishop, Azin Ahrari, Mark Goldszmidt
{"title":"支持有意义的评估和反馈：用于门诊病例回顾的临床推理任务的研究。","authors":"Jacqueline M I Torti, Susan Humphrey Murto, Kristen A Bishop, Azin Ahrari, Mark Goldszmidt","doi":"10.5334/pme.2294","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>Assessing clinical reasoning and offering meaningful feedback to residents through workplace-based assessments remains challenging. Part of this challenge lies not only in articulating how well residents perform clinical tasks, but also in having a shared language to describe the underlying reasoning that supports those tasks. This study aimed to explore clinical reasoning tasks in an ambulatory setting and their relationship to clinical expertise.</p><p><strong>Method: </strong>This single-site instrumental case study explored clinical reasoning of junior and senior residents in new and follow-up rheumatology cases. Case reviews, including resident, attending, and patient interactions were audio-recorded and transcribed. Data analysis combined template and content analysis to explore reasoning. Coding was iterative, with regular consensus meetings among researchers. Findings were confirmed through a focus group with clinic faculty and residents.</p><p><strong>Results: </strong>53 cases were reviewed in ambulatory rheumatology clinics. New consultations focused more on tasks of identifying most likely diagnosis and establishing management plans, whereas follow-up encounters focused on assessing rate of progression, response to treatment, estimating prognosis, and determining follow-up. There were no consistent differences in the number of tasks addressed between junior and senior residents, nor between strong and weak case presentations. However, strong presentations demonstrated selectivity in addressing tasks related to specific patient needs.</p><p><strong>Discussion: </strong>Sharing common patterns of reasoning tasks addressed and omitted can better prepare residents for ambulatory encounters. A shared language around metacognitive tasks can enhance feedback and guide assessment instruments in competency-based training, helping residents broaden their perspectives beyond individual cases.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"15 1","pages":"257-269"},"PeriodicalIF":3.5000,"publicationDate":"2026-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12985855/pdf/","citationCount":"0","resultStr":"{\"title\":\"In Support of Meaningful Assessment and Feedback: A Study of Clinical Reasoning Tasks Used in Ambulatory Case Reviews.\",\"authors\":\"Jacqueline M I Torti, Susan Humphrey Murto, Kristen A Bishop, Azin Ahrari, Mark Goldszmidt\",\"doi\":\"10.5334/pme.2294\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>Assessing clinical reasoning and offering meaningful feedback to residents through workplace-based assessments remains challenging. Part of this challenge lies not only in articulating how well residents perform clinical tasks, but also in having a shared language to describe the underlying reasoning that supports those tasks. This study aimed to explore clinical reasoning tasks in an ambulatory setting and their relationship to clinical expertise.</p><p><strong>Method: </strong>This single-site instrumental case study explored clinical reasoning of junior and senior residents in new and follow-up rheumatology cases. Case reviews, including resident, attending, and patient interactions were audio-recorded and transcribed. Data analysis combined template and content analysis to explore reasoning. Coding was iterative, with regular consensus meetings among researchers. Findings were confirmed through a focus group with clinic faculty and residents.</p><p><strong>Results: </strong>53 cases were reviewed in ambulatory rheumatology clinics. New consultations focused more on tasks of identifying most likely diagnosis and establishing management plans, whereas follow-up encounters focused on assessing rate of progression, response to treatment, estimating prognosis, and determining follow-up. There were no consistent differences in the number of tasks addressed between junior and senior residents, nor between strong and weak case presentations. However, strong presentations demonstrated selectivity in addressing tasks related to specific patient needs.</p><p><strong>Discussion: </strong>Sharing common patterns of reasoning tasks addressed and omitted can better prepare residents for ambulatory encounters. A shared language around metacognitive tasks can enhance feedback and guide assessment instruments in competency-based training, helping residents broaden their perspectives beyond individual cases.</p>\",\"PeriodicalId\":48532,\"journal\":{\"name\":\"Perspectives on Medical Education\",\"volume\":\"15 1\",\"pages\":\"257-269\"},\"PeriodicalIF\":3.5000,\"publicationDate\":\"2026-03-13\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12985855/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Perspectives on Medical Education\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.5334/pme.2294\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2026/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q1\",\"JCRName\":\"EDUCATION, SCIENTIFIC DISCIPLINES\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Perspectives on Medical Education","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.5334/pme.2294","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2026/1/1 0:00:00","PubModel":"eCollection","JCR":"Q1","JCRName":"EDUCATION, SCIENTIFIC DISCIPLINES","Score":null,"Total":0}
In Support of Meaningful Assessment and Feedback: A Study of Clinical Reasoning Tasks Used in Ambulatory Case Reviews.
Introduction: Assessing clinical reasoning and offering meaningful feedback to residents through workplace-based assessments remains challenging. Part of this challenge lies not only in articulating how well residents perform clinical tasks, but also in having a shared language to describe the underlying reasoning that supports those tasks. This study aimed to explore clinical reasoning tasks in an ambulatory setting and their relationship to clinical expertise.
Method: This single-site instrumental case study explored clinical reasoning of junior and senior residents in new and follow-up rheumatology cases. Case reviews, including resident, attending, and patient interactions were audio-recorded and transcribed. Data analysis combined template and content analysis to explore reasoning. Coding was iterative, with regular consensus meetings among researchers. Findings were confirmed through a focus group with clinic faculty and residents.
Results: 53 cases were reviewed in ambulatory rheumatology clinics. New consultations focused more on tasks of identifying most likely diagnosis and establishing management plans, whereas follow-up encounters focused on assessing rate of progression, response to treatment, estimating prognosis, and determining follow-up. There were no consistent differences in the number of tasks addressed between junior and senior residents, nor between strong and weak case presentations. However, strong presentations demonstrated selectivity in addressing tasks related to specific patient needs.
Discussion: Sharing common patterns of reasoning tasks addressed and omitted can better prepare residents for ambulatory encounters. A shared language around metacognitive tasks can enhance feedback and guide assessment instruments in competency-based training, helping residents broaden their perspectives beyond individual cases.
期刊介绍：
Perspectives on Medical Education mission is support and enrich collaborative scholarship between education researchers and clinical educators, and to advance new knowledge regarding clinical education practices.
Official journal of the The Netherlands Association of Medical Education (NVMO).
Perspectives on Medical Education is a non-profit Open Access journal with no charges for authors to submit or publish an article, and the full text of all articles is freely available immediately upon publication, thanks to the sponsorship of The Netherlands Association for Medical Education.
Perspectives on Medical Education is highly visible thanks to its unrestricted online access policy.
Perspectives on Medical Education positions itself at the dynamic intersection of educational research and clinical education. While other journals in the health professional education domain orient predominantly to education researchers or to clinical educators, Perspectives positions itself at the collaborative interface between these perspectives. This unique positioning reflects the journal’s mission to support and enrich collaborative scholarship between education researchers and clinical educators, and to advance new knowledge regarding clinical education practices. Reflecting this mission, the journal both welcomes original research papers arising from scholarly collaborations among clinicians, teachers and researchers and papers providing resources to develop the community’s ability to conduct such collaborative research. The journal’s audience includes researchers and practitioners: researchers who wish to explore challenging questions of health professions education and clinical teachers who wish to both advance their practice and envision for themselves a collaborative role in scholarly educational innovation. This audience of researchers, clinicians and educators is both international and interdisciplinary.
The journal has a long history. In 1982, the journal was founded by the Dutch Association for Medical Education, as a Dutch language journal (Netherlands Journal of Medical Education). As a Dutch journal it fuelled educational research and innovation in the Netherlands. It is one of the factors for the Dutch success in medical education. In 2012, it widened its scope, transforming into an international English language journal. The journal swiftly became international in all aspects: the readers, authors, reviewers and editorial board members.
The editorial board members represent the different parental disciplines in the field of medical education, e.g. clinicians, social scientists, biomedical scientists, statisticians and linguists. Several of them are leading scholars. Three of the editors are in the top ten of most cited authors in the medical education field. Two editors were awarded the Karolinska Institute Prize for Research. Presently, Erik Driessen leads the journal as Editor in Chief.
Perspectives on Medical Education is highly visible thanks to its unrestricted online access policy. It is sponsored by theThe Netherlands Association of Medical Education and offers free manuscript submission.
Perspectives on Medical Education positions itself at the dynamic intersection of educational research and clinical education. While other journals in the health professional education domain orient predominantly to education researchers or to clinical educators, Perspectives positions itself at the collaborative interface between these perspectives. This unique positioning reflects the journal’s mission to support and enrich collaborative scholarship between education researchers and clinical educators, and to advance new knowledge regarding clinical education practices. Reflecting this mission, the journal both welcomes original research papers arising from scholarly collaborations among clinicians, teachers and researchers and papers providing resources to develop the community’s ability to conduct such collaborative research. The journal’s audience includes researchers and practitioners: researchers who wish to explore challenging questions of health professions education and clinical teachers who wish to both advance their practice and envision for themselves a collaborative role in scholarly educational innovation. This audience of researchers, clinicians and educators is both international and interdisciplinary.
The journal has a long history. In 1982, the journal was founded by the Dutch Association for Medical Education, as a Dutch language journal (Netherlands Journal of Medical Education). As a Dutch journal it fuelled educational research and innovation in the Netherlands. It is one of the factors for the Dutch success in medical education. In 2012, it widened its scope, transforming into an international English language journal. The journal swiftly became international in all aspects: the readers, authors, reviewers and editorial board members.
The editorial board members represent the different parental disciplines in the field of medical education, e.g. clinicians, social scientists, biomedical scientists, statisticians and linguists. Several of them are leading scholars. Three of the editors are in the top ten of most cited authors in the medical education field. Two editors were awarded the Karolinska Institute Prize for Research. Presently, Erik Driessen leads the journal as Editor in Chief.
Perspectives on Medical Education is highly visible thanks to its unrestricted online access policy. It is sponsored by theThe Netherlands Association of Medical Education and offers free manuscript submission.
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