1887
Volume 2024, Issue 1
  • ISSN: 0253-8253
  • EISSN: 2227-0426

Abstract

Background: Learning clinical reasoning is less effective in isolation of clinical environments because contextual factors are a significant component in the clinical reasoning process. This study investigated the differences in opinions between novice and expert clinicians on learning clinical reasoning in the workplace.

Materials and Methods: The author used a cross-sectional online survey design to investigate the perceived learning of six clinical reasoning skills in 13 learning opportunities. Questionnaires were emailed to 41 postgraduate psychiatry trainee doctors and 37 faculty members. Data were analyzed descriptively. The Chi-square test was used to compare the responses of the two groups. Statistical significance was set at < 0.05.

Results: The combined response rate was 73.07%. The two groups perceived the learning of advanced clinical reasoning skills to be lower than that of basic skills. There were significant differences in the perceived learning of basic clinical reasoning skills in self-study/exam preparations ( = 0.032), general hospital grand rounds ( = 0.049), and clinical rounds ( = 0.024 for consultant-led rounds and = 0.038 for senior peer-led rounds). There were also significant differences in the perceived learning of advanced clinical reasoning skills among peer-led tutorials ( = 0.04), journal clubs ( = 0.006), morning reports ( = 0.002), and on-call duties ( = 0.031).

Conclusions: The trainees showed a significant preference for structured learning environments rather than clinical environments, especially for advanced clinical reasoning skills. Trainees likely struggled with cognitive overload in clinical environments. Local postgraduate psychiatry programs will likely benefit from implementing multiple educational interventions that facilitate teaching and learning clinical reasoning in complex clinical environments.

Loading

Article metrics loading...

/content/journals/10.5339/qmj.2024.14
2024-04-03
2024-10-12
Loading full text...

Full text loading...

/deliver/fulltext/qmj/2024/1/qmj.2024.14.html?itemId=/content/journals/10.5339/qmj.2024.14&mimeType=html&fmt=ahah

References

  1. Gabriel AViolato C. Problem-solving strategies in psychiatry: differences between experts and novices in diagnostic accuracy and reasoning. Adv Med Educ Pract. 2013 May 30; 4:11–6.
    [Google Scholar]
  2. Linsen AElshout GPols DZwaan LMamede S. Education in clinical reasoning: an experimental study on strategies to foster novice medical students’ engagement in learning activities. Health Profess Educ. 2017 May 30; 4:86–96.
    [Google Scholar]
  3. Loveday TWiggins MFesta MSchell DTwigg D. Pattern recognition as an indicator of diagnostic expertise. Latorre Carmona, P., Sánchez, J., Fred, A. Pattern Recognition - Applications and Methods. Advances in Intelligent Systems and Computing, Berlin: Springer.
    [Google Scholar]
  4. Norman GYoung MBrooks L. Non-analytical models of clinical reasoning: The role of experience. Med Educ. 2007 Nov 14; 41:(12):1140–5.
    [Google Scholar]
  5. Norman G. Research in clinical reasoning: past history and current trends. Med Educ. 2005; 39:(4):418–27.
    [Google Scholar]
  6. Robertson LJ. Clinical reasoning, part 2: novice/expert differences. Br J Occup Therapy. 1996 May 5; 59:(5):212–6. doi: 10.1177/030802269605900507
    [Google Scholar]
  7. Jensen GResnik LHaddad A. Expertise and clinical reasoning. Higgs JJones M Clinical reasoning in the health professions, 2nd edn. Oxford: Butterworth-Heinemann, 2008.
    [Google Scholar]
  8. Süß HM, Oberauer KWittmann WW, Wilhelm OSchulze R. Working-memory capacity explains reasoning ability - And a little bit more. Intelligence. 2002; 30:(3):261–88.
    [Google Scholar]
  9. Hruska PKrigolson OCoderre SMcLaughlin KCortese FDoig C et al.. Working memory, reasoning, and expertise in medicine—insights into their relationship using functional neuroimaging. Adv Health Sci Educ. 2016 Dec 1; 21:(5):935–52.
    [Google Scholar]
  10. Rotgans JI, Schmidt HG, Rosby LV, Tan GJS, Mamede SZwaan L et al.. Evidence supporting dual-process theory of medical diagnosis: a functional near-infrared spectroscopy study. Med Educ. 2019; 53:(2):143–52.
    [Google Scholar]
  11. Konopasky ARamani DOhmer MBattista AArtino AR, McBee E et al.. It totally possibly could be: how a group of military physicians reflect on their clinical reasoning in the presence of contextual factors. Mil Med. 2020 Jan 7; 185:(Supplement_1):575–82.
    [Google Scholar]
  12. Pelaccia TTardif JTriby ECharlin B. An analysis of clinical reasoning through a recent and comprehensive approach: the dual-process theory. Med Educ Online. 2011; 16:(1):16. doi: 10.3402/meo.v16i0.5890
    [Google Scholar]
  13. Choi HH, van Merriënboer JJG, Paas F. Effects of the physical environment on cognitive load and learning: towards a new model of cognitive load. Educ Psychol Rev. 2014; 26:(2):225-244.
    [Google Scholar]
  14. Réa-Neto A. Clinical reasoning--the diagnostic and therapeutic decision process. Rev Assoc Med Bras (1992). 1998 Oct-Dec; 44:(4):301–11.
    [Google Scholar]
  15. McBee ERatcliffe TPicho KSchuwirth LArtino AR, Yepes-Rios AM, et al.. Contextual factors and clinical reasoning: Differences in diagnostic and therapeutic reasoning in board certified versus resident physicians. BMC Med Educ. 2017 Dec 15; 17:(1):211.
    [Google Scholar]
  16. Harendza SKrenz IKlinge AWendt UJanneck M. Implementierung eines clinical-reasoning-kurses im PJ-tertial innere medizin und dessen wirkung auf studentische fähigkeiten der fallpräsentation und der differentialdiagnostik. GMS J Med Educ. 2017 Mar 24; 34:(5):1–13.
    [Google Scholar]
  17. Haring CCools BVan Gurp PVan Der Meer JPostma C. Observable phenomena that reveal medical students’ clinical reasoning ability during expert assessment of their history taking: A qualitative study. BMC Med Educ. 2017 Aug 29; 17:(1):147. doi: 10.1186/s12909-017-1041-x
    [Google Scholar]
  18. Silverman J. Information gathering and clinical reasoning. Brown J, Noble LM, Papageorgiou A, Kidd JClinical Communication in Medicine. Chichester, UK: John Wiley & Sons, Ltd; 2015.
    [Google Scholar]
  19. Nardone DA. Collecting and Analyzing Data: Doing and Thinking. Clinical Methods: The History, Physical, and Laboratory Examinations. Oxford: Butterworths; 1990.
    [Google Scholar]
  20. Ark TK, Brooks LR, Eva KW. Giving learners the best of both worlds: Do clinical teachers need to guard against teaching pattern recognition to novices? Acad Med. 2006; 81:(4):405–9.
    [Google Scholar]
  21. Frank JSnell LSherbino J. CanMEDS 2015 Physician Competency Framework. CanMEDS 2015 Physician Competency Framework. Ottawa: Royal College of Physicians and Surgeons of Canada. 2015.
    [Google Scholar]
  22. The General Medical Council. Recognising and approving trainers: the implementation plan. London: The General Medical Council. 2012.
    [Google Scholar]
  23. Vize R. Why doctors don’t dare go into management. Bmj. 2015; 350:h922.
    [Google Scholar]
  24. Emparanza JI, Cabello JB, Burls AJE. Does evidence-based practice improve patient outcomes? An analysis of a natural experiment in a Spanish hospital. J Eval Clin Pract. 2015 Dec; 21:(6):1059–65.
    [Google Scholar]
  25. Connor LDean JMcNett MTydings DM, Shrout AGorsuch PF, et al.. Evidence-based practice improves patient outcomes and healthcare system return on investment: Findings from a scoping review. Worldviews Evid Based Nurs. 2023 Feb 8; 20:(1):6–15.
    [Google Scholar]
  26. Shah DSachdev H. Evidence-based medicine. Indian J Orthop. 2007 Jan; 41:(1):4–10.
    [Google Scholar]
  27. Rencic J. Twelve tips for teaching expertise in clinical reasoning. Med Teach. 2011; 33:(11):887–92. doi: 10.3109/0142159X.2011.558142
    [Google Scholar]
  28. Schmidt HG, Mamede S. How to improve the teaching of clinical reasoning: a narrative review and a proposal. Med Educ. 2015 Oct; 49:(10):961–73. doi: 10.1111/medu.12775
    [Google Scholar]
  29. Torre DDurning SJ, Rencic JLang VHolmboe EDaniel M. Widening the lens on teaching and assessing clinical reasoning: from “in the head” to “out in the world.” Diagnosis. 2020 Aug 27; 7:(3):181–90.
    [Google Scholar]
  30. Guraya SY. The pedagogy of teaching and assessing clinical reasoning for enhancing the professional competence: a systematic review. Biosci Biotechnol Res Asia. 2016; 13:(3):169.
    [Google Scholar]
  31. Arias DSaxena SVerguet S. Quantifying the global burden of mental disorders and their economic value. EClinicalMedicine. 2022 Dec; 54:101675.
    [Google Scholar]
  32. GBD 2019 Mental Disorders Collaborators. Global, regional, and national burden of 12 mental disorders in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Psychiatry. 2022 Feb; 9:(2):137–50.
    [Google Scholar]
  33. Bener AAbou-Saleh MDafeeah EBhugra D. The prevalence and burden of psychiatric disorders in primary health care visits in Qatar: too little time? J Family Med Prim Care. 2015; 4:(1):89.
    [Google Scholar]
  34. Ministry of Public Health. Mental Healthcare Act 2014. 2014. Bethesda, MA: National Mental Health Strategy.
    [Google Scholar]
  35. Albahari D. Learning Clinical Reasoning: The Experience of Postgraduate Psychiatry Trainee Doctors in Qatar. Teach Learn Med. 2023 May 8;1–14.
    [Google Scholar]
  36. Vidyarthi AR, Kamei RChan KGoh SH, Lek N. Factors associated with medical student clinical reasoning and evidence based medicine practice. Int J Med Educ. 2015 Nov 8; 6:142.
    [Google Scholar]
  37. Cuthbert LTeather DTeather BSharples MDuBoulay G. Expert / Novice differences in Diagnostic Medical Cognition - A Review of the Literature. Computing. 1999; (February):1–33.
    [Google Scholar]
  38. Schmidt HG, Norman GR, Boshuizen HPA. A cognitive perspective on medical expertise: Theory and implications. Academic Medicine. 1990; 65:(10):611–21.
    [Google Scholar]
  39. Bandura A. Human Agency in Social Cognitive Theory. Am Psychol. 1989 Sep; 44:(9):1175–84.
    [Google Scholar]
  40. Torre DDurning SJ. Social cognitive theory: thinking and learning in social settings. Researching Medical Education [Internet]. Chichester, UK: John Wiley & Sons, Ltd; 2015 [cited 2021 Apr 7]. p. 105–16. doi: 10.1002/9781118838983.ch10
    [Google Scholar]
  41. Brown JS, Collins ADuguid P. Situated Cognition and the Culture of Learning. Educational Researcher. 1989; 18:(1):32–42.
    [Google Scholar]
  42. Wilson AL. The promise of situated cognition. New Dir Adult Continuing Educ. 1993 Apr 7; 1993:(57):71–9. doi: 10.1002/ace.36719935709
    [Google Scholar]
  43. SurveyMonkey. SurveyMonkey: The world’s most popular free online survey tool. SurveyMonkey. 2018.
    [Google Scholar]
  44. de Jong T. Cognitive load theory, educational research, and instructional design: some food for thought. Instr Sci. 2010 Mar 27; 38:(2):105–34.
    [Google Scholar]
  45. Houchens NHarrod MFowler KE, Moody SSaint S. How Exemplary Inpatient Teaching Physicians Foster Clinical Reasoning. Am J Med. 2017 Mar 24; 130:(9):1113.e1–e8. doi: 10.1016/j.amjmed.2017.03.050
    [Google Scholar]
  46. Hatala RKeitz SA, Wilson MC, Guyatt G. Beyond journal clubs: Moving toward an integrated evidence-based medicine curriculum. J Gen Intern Med [Internet]. 2006 Aug 24; 21:(5):538–41.
    [Google Scholar]
  47. Macdonald H. Are journal clubs an essential tool for postgraduate education? Bmj. 2011 Mar 2; 342:d1082.
    [Google Scholar]
  48. Pelaccia TTardif JTriby ECharlin B. An analysis of clinical reasoning through a recent and comprehensive approach: The dual-process theory. Med Educ Online. 2011; 16:(1):5890.
    [Google Scholar]
  49. Jia ZZeng XDuan HLu XLi H. A patient-similarity-based model for diagnostic prediction. Int J Med Inform. 2020 Mar 1; 135:104073.
    [Google Scholar]
  50. Byrne LGoslar DJames AKhan MLovett KDavid Morris P et al.. Person-centred care: implications for training in psychiatry Person-Centred Training and Curriculum (PCTC) Scoping Group Special Committee on Professional Practice and Ethics Acknowledgements. 2018 Sep.
    [Google Scholar]
  51. Leppink J. Cognitive load theory: Practical implications and an important challenge. J Taibah Univ Med Sci. 2017 Oct; 12:(5):385–91.
    [Google Scholar]
  52. Szulewski AHowes Dvan Merriënboer JJG, Sweller J. From theory to practice: the application of cognitive load theory to the practice of medicine. Acad Med. 2021 Jan 29; 96:(1):24–30.
    [Google Scholar]
  53. Vyas DOttis EJ, Caligiuri FJ. Teaching clinical reasoning and problem-solving skills using human patient simulation. Am J Pharm Educ. 2011 Nov 10; 75:(9):189.
    [Google Scholar]
  54. Mutter MK, Martindale JR, Shah NGusic ME, Wolf SJ. Case-based teaching: does the addition of high-fidelity simulation make a difference in medical students’ clinical reasoning skills? Med Sci Educ. 2020 Mar 10; 30:(1):307–13. doi: 10.1007/s40670-019-00904-0
    [Google Scholar]
  55. Watari TTokuda YOwada MOnigata K. The utility of virtual patient simulations for clinical reasoning education. Int J Environ Res Public Health. 2020; 17:(15):5325. doi: 10.3390/ijerph17155325
    [Google Scholar]
/content/journals/10.5339/qmj.2024.14
Loading
/content/journals/10.5339/qmj.2024.14
Loading

Data & Media loading...

  • Article Type: Research Article
Keyword(s): clinical reasoningfacultypsychiatry clinical fellowship and psychiatry residency
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error