During the Innovation Room of the Centre of Education and Learning on 11 November 2016, Walter van den Broek (Director of Psychiatric Residency Training at Erasmus MC) and Silvia Mamede (Department of Psychology, Erasmus University), talked about their research on teaching clinical reasoning. This article contains a summary and video of their presentation.
Research on teaching clinical reasoning (the process in which doctors recognize the key features of an ailment) is very scarce. Traditionally, developing medical students’ clinical reasoning has been left to clinical rotations. However, these rotations usually offer limited practice and suboptimal supervision. Medical schools have recently responded by organizing clinical reasoning courses.
The most prevalent approach in clinical reasoning courses is the serial-cue approach. This approach simulates a real clinical encounter, in which students are required to make a step-by-step diagnosis. They are provided with some of the patient's complaints, but need to indicate which additional information they need to arrive at a diagnosis.
While serial-cue is the most prevalent approach in teaching clinical reasoning, it may not be the best. It does not seem consistent with how clinical reasoning is actually learned. Scarce empirical research indicates that other approaches may be more effective:
- Self explanation: while diagnosing clinical cases, students read the case and explain it aloud to themselves. The students are directly presented with the complete case, unlike the step-by-step serial-cue approach.
- Structured reflection: students compare cases in which patients have similar complaints. They are asked to indicate which signs and symptoms support their diagnostic hypothesis, and which ones do not.
To compare the effectiveness of the serial-cue, self-explanation and structured reflection approaches, Silvia Mamede and Walter van den Broek did their own research, testing a total of 385 second year medical students. All of them were presented with the same diagnostic test.
While there might have been some influencing factors (initial competence, participants' perception of the study), the research showed interesting results:
- In the two-week learning phase, students who used the serial-cue approach performed better;
- In the test phase, students who used self-explanation and structured reflection performed better.