Education in Clinical Reasoning: An Experimental Study on Strategies to Foster Novice Medical Students’ Engagement in Learning Activities

Abstract

Purpose

Clinical reasoning forms the interface between medical knowledge and medical practice. However, it is not clear how to organize education to foster the development of clinical reasoning. This study compared two strategies to teach clinical reasoning.

Method

As part of a regular clinical reasoning course 333 students participated in a two-phase experiment. In the learning phase, participants were randomly assigned to either the conventional strategy (CS) or the new strategy (NS). Participants in the CS solved a clinical case using a written description of a patient encounter and individual study. Participants assigned to the NS solved the same case using a video patient encounter and group discussion. One week later, all participants took the same diagnostic performance test. Performance on the diagnostic test and differences between the groups regarding their interest, cognitive engagement, appreciation of the educational activity, and time investment in self-study were analyzed.

Results

There was no significant effect of teaching strategy on diagnostic performance (p = .23). Students in the NS condition showed more interest during the session (p = .003) and were more appreciative of the course when assigning an overall grade than the students in the CS condition (p<.001). The NS students reported having spent fewer hours studying the clinical case individually before the group session than the CS students (p<.001).

Discussion

The NS resulted in more students’ involvement and higher appreciation of the learning activity compared to the CS. There was no difference in diagnostic accuracy, but the NS seems more efficient: to achieve the same performance, the NS students needed only half the preparation time before the learning session than the students working under the CS. This higher efficiency may be due to the benefits of small-group learning, but clarifying this finding requires further investigation.