Teaching of clinical reasoning to internal medicine residents using a case-based learning model

Abstract

Introduction: Clinical reasoning represents a central competence for Internal Medicine residents. The objective of this study was to describe the development of an interactive course aimed at enhancing the clinical reasoning skills of residents by using a case-based learning model. Materials and methods: The course was directed at the residents of Medical Clinics «1» and «3» of Maciel Hospital in Montevideo, Uruguay. Nine interactive clinical sessions with real patients were developed, previously obtaining their informed consent. Teachers were assigned as discussion facilitators. One resident took the medical history and the focused physical examination (patient present) and then presented the clinical reasoning process orally (patient absent). Afterwards, each teacher provided an oral feedback. A post-course written questionnaire, combining a Likert scale and comments, was used to assess the participant level of satisfaction. Results: A mean of 11 ± 3 residents attended to the course. The major cause of non-attendance was working on the ward. Residents rated the course favourably, with over 90% in the «highly satisfactory» and «satisfactory» categories combined. They were interested in incorporating the course into the residency program. Teachers rated the activity as very positive, with over 98% in the «highly satisfactory» and «satisfactory» categories combined. They considered the course as a possible tool for assessing resident performance. Conclusion: Using interactive clinical sessions and a case-based learning model for teaching clinical reasoning skills showed to be a widely accepted educational strategy among residents and teachers of Internal Medicine.