Developing Clinical Reasoning in Medical Students - A Scoping Review

AbstractClinical reasoning is the thought process that guides practice. Although a plethora of clinical reasoning studies in healthcare professionals exists, the majority appear to originate from Western cultures. A scoping review was undertaken to examine clinical reasoning related research across Asian cultures. PubMed, SciVerse Scopus, Web of Science and Airiti Library databases were searched. Inclusion criteria included full-text articles published in Asian countries (2007 to 2019). Search terms included clinical reasoning, thinking process, differential diagnosis, decision making, problem-based learning, critical thinking, healthcare profession, institution, medical students and nursing students. After applying exclusion criteria, n = 240 were included in the review. The number of publications increased in 2012 (from 5%, n = 13 in 2011 to 9%, n = 22) with a steady increase onwards to 12% (n = 29) in 2016. South Korea published the most articles (19%, n = 46) followed by Iran (17%, n = 41). Nurse Education Today published 11% of the articles (n = 26), followed by BMC Medical Education (5%, n = 13). Nursing and Medical students account for the largest population groups studied. Analysis of the articles resulted in seven themes: Evaluation of existing courses (30%, n = 73) being the most frequently identified theme. Only seven comparative articles showed cultural implications, but none provided direct evidence of the impact of culture on clinical reasoning. We illuminate the potential necessity of further research in clinical reasoning, specifically with a focus on how clinical reasoning is affected by national culture. A better understanding of current clinical reasoning research in Asian cultures may assist curricula developers in establishing a culturally appropriate learning environment.

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A Scoping Review of Professional Identity Formation in Undergraduate Medical Education

Journal of General Internal Medicine ◽

10.1007/s11606-021-07024-9 ◽

2021 ◽

Author(s):

Shiva Sarraf-Yazdi ◽

Yao Neng Teo ◽

Ashley Ern Hui How ◽

Yao Hao Teo ◽

Sherill Goh ◽

...

Keyword(s):

Medical Students ◽

Identity Development ◽

Medical School ◽

Professional Identity ◽

Identity Formation ◽

Scoping Review ◽

Medical Schools ◽

Professional Identity Formation ◽

Enabling Factors ◽

Content Analyses

Abstract Background Professional identity formation (PIF) in medical students is a multifactorial phenomenon, shaped by ways that clinical and non-clinical experiences, expectations and environmental factors merge with individual values, beliefs and obligations. The relationship between students’ evolving professional identity and self-identity or personhood remains ill-defined, making it challenging for medical schools to support PIF systematically and strategically. Primarily, to capture prevailing literature on PIF in medical school education, and secondarily, to ascertain how PIF influences on medical students may be viewed through the lens of the ring theory of personhood (RToP) and to identify ways that medical schools support PIF. Methods A systematic scoping review was conducted using the systematic evidence-based approach. Articles published between 1 January 2000 and 1 July 2020 related to PIF in medical students were searched using PubMed, Embase, PsycINFO, ERIC and Scopus. Articles of all study designs (quantitative and qualitative), published or translated into English, were included. Concurrent thematic and directed content analyses were used to evaluate the data. Results A total of 10443 abstracts were identified, 272 full-text articles evaluated, and 76 articles included. Thematic and directed content analyses revealed similar themes and categories as follows: characteristics of PIF in relation to professionalism, role of socialization in PIF, PIF enablers and barriers, and medical school approaches to supporting PIF. Discussion PIF involves iterative construction, deconstruction and inculcation of professional beliefs, values and behaviours into a pre-existent identity. Through the lens of RToP, factors were elucidated that promote or hinder students’ identity development on individual, relational or societal levels. If inadequately or inappropriately supported, enabling factors become barriers to PIF. Medical schools employ an all-encompassing approach to support PIF, illuminating the need for distinct and deliberate longitudinal monitoring and mentoring to foster students’ balanced integration of personal and professional identities over time.

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The impact of death and dying on the personhood of medical students: a systematic scoping review

BMC Medical Education ◽

10.1186/s12909-020-02411-y ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Chong Yao Ho ◽

Cheryl Shumin Kow ◽

Chin Howe Joshua Chia ◽

Jia Ying Low ◽

Yong Hao Melvin Lai ◽

...

Keyword(s):

Medical Students ◽

Scoping Review ◽

Death And Dying ◽

Support Mechanism ◽

Resource Limited ◽

Dying Patients ◽

Concurrent Use ◽

Effective Training ◽

Longitudinal Support ◽

The Impact

Abstract Background The re-introduction of medical students into healthcare systems struggling with the COVID-19 pandemic raises concerns as to whether they will be supported when confronted with death and dying patients in resource-limited settings and with reduced support from senior clinicians. Better understanding of how medical students respond to death and dying will inform educationalists and clinicians on how to best support them. Methods We adopt Krishna’s Systematic Evidence Based Approach to carry out a Systematic Scoping Review (SSR in SEBA) on the impact of death and dying on medical students. This structured search process and concurrent use of thematic and directed content analysis of data from six databases (Split Approach) enhances the transparency and reproducibility of this review. Results Seven thousand six hundred nineteen were identified, 149 articles reviewed and 52 articles included. The Split Approach revealed similar themes and categories that correspond to the Innate, Individual, Relational and Societal domains in the Ring Theory of Personhood. Conclusion Facing death and dying amongst their patients affect how medical students envisage their personhood. This underlines the need for timely, holistic and longitudinal support systems to ensure that problems faced are addressed early. To do so, there must be effective training and a structured support mechanism.

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Interprofessional initiatives between the human health professions and veterinary medical students: a scoping review

Journal of Interprofessional Care ◽

10.3109/13561820.2014.895979 ◽

2014 ◽

Vol 28 (4) ◽

pp. 323-330 ◽

Cited By ~ 10

Author(s):

Molly Courtenay ◽

Pat Conrad ◽

Michael Wilkes ◽

Roberto La Ragione ◽

Noel Fitzpatrick

Keyword(s):

Medical Students ◽

Human Health ◽

Scoping Review ◽

Health Professions ◽

Veterinary Medical Students

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Clinical reasoning and medical education: Scoping Review

Educación Médica ◽

10.1016/j.edumed.2020.11.015 ◽

2021 ◽

Author(s):

Giovanni García-Castro ◽

Francisco Javier Ruiz-Ortega

Keyword(s):

Medical Education ◽

Clinical Reasoning ◽

Scoping Review

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

Health Professions Education ◽

10.1016/j.hpe.2017.03.003 ◽

2018 ◽

Vol 4 (2) ◽

pp. 86-96 ◽

Cited By ~ 4

Author(s):

Alexander Linsen ◽

Gijs Elshout ◽

David Pols ◽

Laura Zwaan ◽

Sílvia Mamede

Keyword(s):

Experimental Study ◽

Medical Students ◽

Clinical Reasoning ◽

Learning Activities

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Corrigendum to “How does questioning influence nursing students' clinical reasoning in problem-based learning? A scoping review” [Nurse Educ. Today 65 (2018) 108–115]

Nurse Education Today ◽

10.1016/j.nedt.2018.05.003 ◽

2018 ◽

Vol 67 ◽

pp. 124

Author(s):

Sophia Merisier ◽

Caroline Larue ◽

Louise Boyer

Keyword(s):

Nursing Students ◽

Clinical Reasoning ◽

Scoping Review ◽

Problem Based Learning

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First-year medical students’ calibration bias and accuracy across clinical reasoning activities

Advances in Health Sciences Education ◽

10.1007/s10459-019-09897-2 ◽

2019 ◽

Vol 24 (4) ◽

pp. 767-781 ◽

Cited By ~ 4

Author(s):

Timothy J. Cleary ◽

Abigail Konopasky ◽

Jeffrey S. La Rochelle ◽

Brian E. Neubauer ◽

Steven J. Durning ◽

...

Keyword(s):

Medical Students ◽

Clinical Reasoning ◽

First Year ◽

First Year Medical Students

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Interprofessional communication (IPC) for medical students: a scoping review

BMC Medical Education ◽

10.1186/s12909-020-02296-x ◽

2020 ◽

Vol 20 (1) ◽

Cited By ~ 1

Author(s):

Chermaine Bok ◽

Cheng Han Ng ◽

Jeffery Wei Heng Koh ◽

Zhi Hao Ong ◽

Haziratul Zakirah Binte Ghazali ◽

...

Keyword(s):

Content Analysis ◽

Medical Students ◽

Scoping Review ◽

Full Text ◽

Healthcare Professionals ◽

Medical Schools ◽

Training Process ◽

Interprofessional Communication ◽

Competency Based ◽

Evidenced Based

Abstract Background Effective Interprofessional Communication (IPC) between healthcare professionals enhances teamwork and improves patient care. Yet IPC training remains poorly structured in medical schools. To address this gap, a scoping review is proposed to study current IPC training approaches in medical schools. Methods Krishna’s Systematic Evidence Based Approach (SEBA) was used to guide a scoping review of IPC training for medical students published between 1 January 2000 to 31 December 2018 in PubMed, ScienceDirect, JSTOR, Google Scholar, ERIC, Embase, Scopus and PsycINFO. The data accrued was independently analysed using thematic and content analysis to enhance the reproducibility and transparency of this SEBA guided review. Results 17,809 titles and abstracts were found, 250 full-text articles were reviewed and 73 full text articles were included. Directed Content analysis revealed 4 categories corresponding to the levels of the Miller’s Pyramid whilst thematic analysis revealed 5 themes including the indications, stages of trainings and evaluations, content, challenges and outcomes of IPC training. Many longitudinal programs were designed around the levels of Miller’s Pyramid. Conclusion IPC training is a stage-wise, competency-based learning process that pivots on a learner-centric spiralled curriculum. Progress from one stage to the next requires attainment of the particular competencies within each stage of the training process. Whilst further studies into the dynamics of IPC interactions, assessment methods and structuring of these programs are required, we forward an evidenced based framework to guide design of future IPC programs.

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