Teaching Clinical Reasoning to Medical Students: A Case-Based Illness Script Worksheet Approach

Case-based learning (CBL) is a newer modality of teaching healthcare, combining medical theory and practices. Many researchs reported effectivity of CBL to improve student-centered learning. The aim of this study is to evaluate how CBL improved students’ clinical reasoning compared with other method such as problem-based learning. An interventional research involved 4th grade medical students receiving PBL and CBL methods supervised by a tutor or instructure. An alternative method combining CBL and structured role play (in an Integrated-Patient Management method) also performed using clinical scenario with medical practice setting. The result showed that student received CBL had better clinical reasoning indicated from better miniquizz result compared with PBL students (p < 0,05, Mann Whitney U test. Students exposed with CBL had final MCQ and essay exam grade compared with unexposed students. Students exposed with CBL also had better clinical skill indicated from Objective Structure Clinical Examination (OSCE) result (p < 0,05, independent t test). Students’ acceptance level on CBL method is 79, 4%. It is concluded that compared with PBL, CBL is more effective in improved students’ performance, learning outcomes and clinical reasoning and also had high acceptance among medical students.

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Integrating clinical reasoning principles in case-based learning sessions for first-year medical students: Lessons learned

Research and Development in Medical Education ◽

10.15171/rdme.2019.004 ◽

2019 ◽

Vol 8 (1) ◽

pp. 20-23

Author(s):

Dinesh Kumar ◽

Ramakrishnan Rajprasath ◽

Magi Murugan

Keyword(s):

Medical Education ◽

Medical Students ◽

Clinical Reasoning ◽

A Priori ◽

Lessons Learned ◽

First Year ◽

Perceived Acceptance ◽

Case Based Learning ◽

First Year Medical Students ◽

Case Based

Background: Conventional pedagogies for case-based learning are designed with the intention of helping the student appreciate the relevance of content they learn and kindle their curiosity. However, these pedagogies embody certain shortcomings which inhibit them from reaching the intended objectives. The main aim of our initiative is to improve traditional case-based learning using the principles of clinical reasoning. Methods: A priori, two sessions were conducted in which two vignettes were administered to first-year medical students. We obtained the perceived acceptance which was equivalent to Kirkpatrick level 1 learning outcomes. Results: Overall outcomes were highly positive in terms of acceptability, fostering curiosity, increasing the relevance of learned content, and helping students learn to think in a logical way. Conclusion: With the increasing need for incorporating clinical reasoning skills in medical education, it is imperative that these skills are taught beginning with the preclinical years of medical education.

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How to develop clinical reasoning in medical students and interns based on illness script theory: An experimental study

Medical Journal of the Islamic Republic of Iran ◽

10.47176/mjiri.34.9 ◽

2020 ◽

Author(s):

Somayeh Delavari ◽

Alireza Monajemi ◽

Hamid Reza Baradaran ◽

Phyo Kyaw Myint ◽

Minoo Yaghmae ◽

...

Keyword(s):

Experimental Study ◽

Medical Students ◽

Clinical Reasoning ◽

Script Theory ◽

Illness Script

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Illness script development in pre-clinical education through case-based clinical reasoning training

International Journal of Medical Education ◽

10.5116/ijme.5a5b.24a9 ◽

2018 ◽

Vol 9 ◽

pp. 35-41 ◽

Cited By ~ 7

Author(s):

Yvette Keemink ◽

Eugene J.F.M. Custers ◽

Savannah van Dijk ◽

Olle ten Cate

Keyword(s):

Clinical Reasoning ◽

Clinical Education ◽

Illness Script ◽

Case Based

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Case-Based Teaching: Does the Addition of High-Fidelity Simulation Make a Difference in Medical Students’ Clinical Reasoning Skills?

Medical Science Educator ◽

10.1007/s40670-019-00904-0 ◽

2020 ◽

Vol 30 (1) ◽

pp. 307-313 ◽

Cited By ~ 1

Author(s):

Mary Kathryn Mutter ◽

James R. Martindale ◽

Neeral Shah ◽

Maryellen E. Gusic ◽

Stephen J. Wolf

Keyword(s):

Medical Students ◽

Clinical Reasoning ◽

High Fidelity ◽

High Fidelity Simulation ◽

Reasoning Skills ◽

Clinical Reasoning Skills ◽

Case Based

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Medical students’ thought process while solving problems in 3 different types of clinical assessments in Korea: clinical performance examination, multimedia case-based assessment, and modified essay question

Journal of Educational Evaluation for Health Professions ◽

10.3352/jeehp.2019.16.10 ◽

2019 ◽

Vol 16 ◽

pp. 10 ◽

Cited By ~ 1

Author(s):

Sejin Kim ◽

Ikseon Choi ◽

Bo Young Yoon ◽

Min Jeong Kwon ◽

Seok-jin Choi ◽

...

Keyword(s):

Medical Students ◽

Clinical Reasoning ◽

Test Performance ◽

Deductive Reasoning ◽

Clinical Performance ◽

Clinical Assessments ◽

Different Types ◽

Essay Question ◽

Performance Examination ◽

Case Based

Purpose: This study aimed to explore students’ cognitive patterns while solving clinical problems in 3 different types of assessments—clinical performance examination (CPX), multimedia case-based assessment (CBA), and modified essay question (MEQ)—and thereby to understand how different types of assessments stimulate different patterns of thinking.Methods: A total of 6 test-performance cases from 2 fourth-year medical students were used in this cross-case study. Data were collected through one-on-one interviews using a stimulated recall protocol where students were shown videos of themselves taking each assessment and asked to elaborate on what they were thinking. The unit of analysis was the smallest phrases or sentences in the participants’ narratives that represented meaningful cognitive occurrences. The narrative data were reorganized chronologically and then analyzed according to the hypothetico-deductive reasoning framework for clinical reasoning.Results: Both participants demonstrated similar proportional frequencies of clinical reasoning patterns on the same clinical assessments. The results also revealed that the three different assessment types may stimulate different patterns of clinical reasoning. For example, the CPX strongly promoted the participants’ reasoning related to inquiry strategy, while the MEQ strongly promoted hypothesis generation. Similarly, data analysis and synthesis by the participants were more strongly stimulated by the CBA than by the other assessment types.Conclusion: This study found that different assessment designs stimulated different patterns of thinking during problem-solving. This finding can contribute to the search for ways to improve current clinical assessments. Importantly, the research method used in this study can be utilized as an alternative way to examine the validity of clinical assessments.

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Teaching clinical reasoning to undergraduate medical students by illness script method: a randomized controlled trial

BMC Medical Education ◽

10.1186/s12909-021-02522-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Mana Moghadami ◽

Mitra Amini ◽

Mohsen Moghadami ◽

Bhavin Dalal ◽

Bernard Charlin

Keyword(s):

Medical Students ◽

Clinical Reasoning ◽

Controlled Trial ◽

Intervention Group ◽

Signs And Symptoms ◽

Control Group ◽

Illness Script ◽

Fourth Year Medical Students ◽

Reasoning Skills ◽

Clinical Reasoning Skills

Abstract Background The illness script method employs a theoretical outline (e.g., epidemiology, pathophysiology, signs and symptoms, diagnostic tests, interventions) to clarify how clinicians organized medical knowledge for clinical reasoning in the diagnosis domain. We hypothesized that an educational intervention based on the illness script method would improve medical students’ clinical reasoning skills in the diagnosis domain. Methods This study is a randomized controlled trial involving 100 fourth-year medical students in Shiraz Medical School, Iran. Fifty students were randomized to the intervention group, who were taught clinical reasoning skills based on the illness script method for three diseases during one clinical scenario. Another 50 students were randomized to the control group, who were taught the clinical presentation based on signs and symptoms of the same three diseases as the intervention group. The outcomes of interest were learner satisfaction with the intervention and posttest scores on both an internally developed knowledge test and a Script Concordance Test (SCT). Results Of the hundred participating fourth-year medical students, 47 (47%) were male, and 53 (53%) were female. On the knowledge test, there was no difference in pretest scores between the intervention and control group, which suggested a similar baseline knowledge in both groups; however, posttest scores in the intervention group were (15.74 ± 2.47 out of 20) statistically significantly higher than the control group (14.38 ± 2.59 out of 20, P = 0.009). On the SCT, the mean score for the intervention group (6.12 ± 1.95 out of 10) was significantly higher than the control group (4.54 ± 1.56 out of 10; P = 0.0001). Learner satisfaction data indicated that the intervention was well-received by students. Conclusion Teaching with the illness script method was an effective way to improve students’ clinical reasoning skills in the diagnosis domain suggested by posttest and SCT scores for specific clinical scenarios. Whether this approach translates to improved generalized clinical reasoning skills in real clinical settings merits further study.

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