Introductory Clinical Reasoning Curriculum

Abstract

Clinical reasoning is a fundamental skill necessary to the practice of medicine. For the novice learner, it is a difficult skill to master. Additionally, most teachers have a difficult time making the process of clinical reasoning explicit and evident to the beginner student. Based on student feedback, we conducted an extensive review of the topic, identifying key articles and workshops, and created a new clinical reasoning curriculum in the first-and second-year On Doctoring course at the Geisel School of Medicine at Dartmouth. To make these sessions interactive, we used a flipped classroom pedagogy in which students review a syllabus and other material prior to class to enhance case discussion and practice of clinical reasoning skills during class. The curriculum was received favorably by students and facilitators. Faculty facilitators noted improvement in the assessment and plan portions of student case presentations and write-ups. Feedback from our students was positive, with over 90% of students identifying satisfaction with the sessions on their midyear course feedback and close to 80% of students on their year-end course feedback. We are evaluating whether it has resulted in augmented clinical reasoning skills in the third year of medical school. Published materials on introductory student clinical reasoning curricula are limited. Our curriculum serves as a model to introduce clinical reasoning to students prior to immersion in their clinical rotations.