Teaching clinical reasoning by making thinking visible: an action research project with allied health clinical educators

BMC Medical Education

Clinton Golding²  Clare Delany¹ 

[1]Children’s Bioethics Centre, at the Royal Children’s Hospital, Melbourne, Australia

[2]Honorary Senior Fellow of the Centre for Higher Education, University of Melbourne, Melbourne, Australia

关键词: Action research;    Professional development;    Clinical education;    Diagnostic reasoning;    Clinical reasoning;   

Others  :  1135637
DOI  :  10.1186/1472-6920-14-20

 received in 2013-11-09, accepted in 2014-01-27,  发布年份 2014

【 摘 要 】

Background

Clinical reasoning is fundamental to all forms of professional health practice, however it is also difficult to teach and learn because it is complex, tacit, and effectively invisible for students. In this paper we present an approach for teaching clinical reasoning based on making expert thinking visible and accessible to students.

Methods

Twenty-one experienced allied health clinical educators from three tertiary Australian hospitals attended up to seven action research discussion sessions, where they developed a tentative heuristic of their own clinical reasoning, trialled it with students, evaluated if it helped their students to reason clinically, and then refined it so the heuristic was targeted to developing each student’s reasoning skills. Data included participants’ written descriptions of the thinking routines they developed and trialed with their students and the transcribed action research discussion sessions. Content analysis was used to summarise this data and categorise themes about teaching and learning clinical reasoning.

Results

Two overriding themes emerged from participants’ reports about using the ‘making thinking visible approach’. The first was a specific focus by participating educators on students’ understanding of the reasoning process and the second was heightened awareness of personal teaching styles and approaches to teaching clinical reasoning.

Conclusions

We suggest that the making thinking visible approach has potential to assist educators to become more reflective about their clinical reasoning teaching and acts as a scaffold to assist them to articulate their own expert reasoning and for students to access and use.

【 授权许可】

   
2014 Delany and Golding; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Norman G: Research in clinical reasoning. Med Educ 2005, 39(4):418-427.
• [2]Ajjawi R, Higgs J: Core components of communication of clinical reasoning. Advances in Health Sci Educ 2012, 17(1):107-119.
• [3]Eva KW: What every teacher needs to know about clinical reasoning. Med Educ 2005, 39(1):98-106.
• [4]Durning SJ, Artino AR Jr, Pangaro LN, van der Vleuten C, Schuwirth L: Context and clinical reasoning. Advances in Health Sci Educ 2011, 45(9):927-938.
• [5]Ryan S, Higgs J: Teaching And Learning Clinical Reasoning. In Clinical Reasoning In The Health Professions. 3rd edition. Edited by Higgs J, Jones M, Loftus S, Christensen N. Amsterdam: Elsevier; 2008:379-87.
• [6]Ark TK, Brooks LR, Eva KW: The benefits of flexibility. Med Educ 2007, 41(3):281-287.
• [7]Higgs J, Jones M, Loftus S, Christensen N: Clinical Reasoning In The Health Professions. 3rd edition. Amsterdam: Elsevier; 2008.
• [8]Edwards I, Jones M, Carr J, Braunack-Mayer A, Jensen G: Clinical reasoning strategies in physical therapy. Phys Ther 2004, 84(4):312-330.
• [9]Higgs J, Burn A, Jones M: Integrating clinical reasoning and evidence-based practice. Am Assoc of Critical-Care Nurses 2001, 12(4):482-490.
• [10]Charlin B, Tardif J, Boshuizen HP: Scripts and medical diagnostic knowledge: theory and applications for clinical reasoning instruction and research. Academic Med 2000, 75(2):182-190.
• [11]Bargh J: Unconscious thought theory and its discontents. Soc Cogn 2011, 29(6):629-647.
• [12]Reilly BM: Inconvenient truths about effective clinical teaching. Lancet 2007, 370(9588):705-711.
• [13]Hill S: Troublesome knowledge: why don’t they understand? Health Inf Libr J 2010, 27(1):80-83.
• [14]McAllister L, Rose M: Speech-Language Pathology Students: Learning Clinical Reasoning. In Clinical Reasoning In The Health Professions. Edited by Higgs J, Jones M, Loftus S, Christensen N. Amsterdam: Elsevier; 2008:397-404.
• [15]Fish D, de Cossart L: Thinking outside the (tick) Box: rescuing professionalish and professional judgment. Med Educ 2006, 40:403-404.
• [16]Ritchhart R, Perkins DN: Life in the mindful classroom: nurturing the disposition of mindfulness. J Soc Issues 2000, 56(1):27-47.
• [17]Golding C: Educating for critical thinking. Higher Educ Res and Develop 2011, 30(3):357-379.
• [18]Epstein A, Shulman L, Sprafka S: Medical Problem Solving: An Analysis Of Clinical Reasoning. Cambridge, MA: Harvard University Press; 1978.
• [19]Lempp H, Seale C: The hidden curriculum in undergraduate medical education. British Med Jour 2004, 329(7469):770-773.
• [20]Gay S, Bartlett M, McKinley R: Teaching clinical reasoning to medical students. Clin Teach 2013, 10:308-312.
• [21]Ritchhart R, Church M, Morrison K: Making Thinking Visible. San-Fransisco: Jossey Bass; 2011.
• [22]de Bono E: Serious Creativity. New York: HarperBusiness; 1992.
• [23]Novak JD, Canas AJ: Theoretical origins of concept maps, how to construct them and uses in education. Reflecting Education 2007, 3(1):29-42.
• [24]Daley BJ, Torre DM: Concept maps in medical education: an analytical literature review. Med Educ 2010, 44(5):440-448.
• [25]La Rochelle JS, Durning SJ, Pangaro LN, Artino AR, van der Vleuten CP, Schuwirth L: Authenticity of instruction and student performance. Med Educ 2011, 45(8):807-817.
• [26]Van Merriënboer J, Sweller J: Cognitive load theory and complex learning. Educ Psych Rev 2005, 17(2):147-177.
• [27]Dhaliwal G: Developing teachers of clinical reasoning. Clin Teach 2013, 10:313-317.
• [28]Mamede S, Schmidt H: The structure of reflective practice in medicine. Med Educ 2004, 38:1302-1308.
• [29]Ajjawi R, Higgs J: Learning to reason: a journey of professional socialisation. Advances in Health Sci Educ 2008, 13(2):133-150.
• [30]Lave J, Wenger E: Situated learning: Legitimate Peripheral Participation. Cambridge: Cambridge University Press; 1991.
• [31]Vygotsky L: Mind In Society: The Development Of The Higher Psychological Processes. Cambridge: Harvard University Press; 1978.
• [32]Clouder L: Becoming professional: exploring the complexities of professional socialization in health and social care. Learn Health Soc Care 2003, 2(4):213-222.
• [33]Egan T, Jaye C: Communities of clinical practice. Health 2009, 13(1):107-125.
• [34]Wenger E: Communities Of Practice. Cambridge: Cambridge University Press; 1998.
• [35]Schön D: The Reflective Practitioner. New York: Basic books; 1983.
• [36]Kell C, Jones L: Mapping placement educators’ conceptions of teaching. Physiotherapy 2007, 93(4):273-282.
• [37]Cohen L, Manion L, Morrison K, Morisson KRB: Research Methods In Education. Chicago: Psychology Press; 2007.
• [38]Dewar B, Sharp C: Using evidence: how action learning can support individual and organisational learning through action research. Educ Action Res 2006, 14(2):219-237.
• [39]McNiff J, Whitehead J: All You Need To Know About Action Research. London: Sage; 2006.
• [40]Burchell H, Dyson J: Action research in higher education: exploring ways of creating and holding the space for reflection. Educ Action Res 2005, 13(2):291-300.
• [41]Notzer N, Abramovitz R: Can brief workshops improve clinical instruction? Med Educ 2008, 42:152-156.
• [42]Kilminster S, Jolly B: Effective supervision in clinical practice settings. Med Educ 2000, 34:827-840.
• [43]van de Ridder J, Stokking K, McCaghie W, ten Cate O: What is feedback in clinical education? Med Educ 2008, 42:189-197.
• [44]Yeates PJA, Stewart J, Barton JR: What can we expect of clinical teachers? Med Educ 2008, 42(2):134-142.
• [45]Weurlander M, Stenfors-Hayes T: Developing medical teachers’ thinking and practice. Higher Educ Res and Develop 2008, 27(2):143-153.
• [46]Crow J, Smith L, Keenan I: Journeying between the Education and Hospital Zones in a collaborative action research project. Ed Action Research 2006, 14(2):287-306.
• [47]Trevitt C: Learning in academia is more than academic learning: action research in academic practice for and with medical academics. Educ Action Res 2008, 16(4):495-515.
• [48]Harland T: University Teaching. London: Routledge; 2012.
• [49]Kolb D: Experiential Learning. USA: Prentice-Hall; 1984.
• [50]Delany C, Golding C, Bialocerkowski A: Teaching for thinking in clinical education. Focus on Health Prof Educ 2013, 14(2):44-56.
• [51]Graneheim UH, Lundman B: Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today 2004, 24(2):105-112.
• [52]Downe-Wamboldt B: Content analysis: method, applications, and issues. Health Care Women Int 1992, 13:313-321.
• [53]Liamputtong P: Qualitative data analysis. Health Promot J Austr 2009, 20(2):133-139.
• [54]Zuber-Skerritt O: Professional Development In Higher Education. London: Kogan Page Ltd; 1992.
• [55]McNiff J: Action Research: Principles And Practice. London: Routledge; 1988.
• [56]Carr W, Kemmis S: Becoming Critical. London: The Falmer Press; 1986.
• [57]Cohen D: Professions Of Human Improvement: Predicaments Of Teaching. In Educational Deliberations. Edited by Nisan M, Schremer O. Jerusalem: Keter; 2005:278-294.
• [58]Swanwick T: See one, do one, then what? faculty development in postgraduate medical education. Postgrad Med J 2008, 84(993):339.
• [59]Delany C, Watkin D: A study of critical reflection in health professional education. Advances in Health Sci Educ 2009, 14(3):411-429.
• [60]Ho A, Watkins D, Kelly M: The conceptual change approach to improving teaching and learning. Higher Educ 2001, 42(2):143-169.
• [61]Bleakley A: Curriculum as conversation. Advances in Health Sci Educ 2009, 14(3):297-301.
• [62]Zuber-Skerritt O: Improving learning and teaching through action learning and action research. High Ed Res and Develop 1993, 12(1):45-58.
• [63]Shulman L: Knowledge and teaching: foundations of the new reform. Harv Educ Rev 1987, 57(1):1-22.
• [64]Atkinson K, Ajjawi R, Cooing N: Promoting clinical reasoning in general practice trainees: role of the clinical teacher. Clin Teach 2011, 8:176-180.
• [65]Delany C, Bragge P: A study of physiotherapy students’ and clinical educators’ perceptions of learning and teaching. Med Teach 2009, 31(9):402-411.
• [66]Biggs J: Enhancing teaching through constructive alignment. Higher Ed 1996, 32(3):347-364.
• [67]Hafler JP, Ownby AR, Thompson BM, Fasser CE, Grigsby K, Haidet P, Kahn MJ, Hafferty FW: Decoding the learning environment of medical education. Academic Med 2011, 86(4):440.
• [68]Jensen GM, Gwyer J, Shepard KF, Hack LM: Expert practice in physical therapy. Phys Ther 2000, 80:28-43.
• [69]Green J, Britten N: Qualitative research and evidence based medicine. BMJ 1998, 316(7139):1230-1232.
• [70]Morse J, Singleton J: Exploring the technical aspects of “Fit” in qualitative research. Qualitative Health Res 2001, 11(6):841-847.