Observable phenomena that reveal medical students' clinical reasoning ability during expert assessment of their history taking: a qualitative study

BMC Medical Education

Research Article

Cornelis T. Postma¹  Bernadette M. Cools¹  Petra J. M. van Gurp¹  Catharina M. Haring¹  Jos W. M. van der Meer¹ 

[1] Department of Internal Medicine (463), Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, the Netherlands;

关键词: Clinical reasoning;    History taking;    Assessment;    Undergraduate medical education;   

DOI  :  10.1186/s12909-017-0983-3

 received in 2016-05-10, accepted in 2017-08-16,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundDuring their clerkships, medical students are meant to expand their clinical reasoning skills during their patient encounters. Observation of these encounters could reveal important information on the students’ clinical reasoning abilities, especially during history taking.MethodsA grounded theory approach was used to analyze what expert physicians apply as indicators in their assessment of medical students’ diagnostic reasoning abilities during history taking. Twelve randomly selected clinical encounter recordings of students at the end of the internal medicine clerkships were observed by six expert assessors, who were prompted to formulate their assessment criteria in a think-aloud procedure. These formulations were then analyzed to identify the common denominators and leading principles.ResultsThe main indicators of clinical reasoning ability were abstracted from students’ observable acts during history taking in the encounter. These were: taking control, recognizing and responding to relevant information, specifying symptoms, asking specific questions that point to pathophysiological thinking, placing questions in a logical order, checking agreement with patients, summarizing and body language. In addition, patients’ acts and the course, result and efficiency of the conversation were identified as indicators of clinical reasoning, whereas context, using self as a reference, and emotion/feelings were identified by the clinicians as variables in their assessment of clinical reasoning.ConclusionsIn observing and assessing clinical reasoning during history taking by medical students, general and specific phenomena to be used as indicators for this process could be identified. These phenomena can be traced back to theories on the development and the process of clinical reasoning.

【 授权许可】

CC BY   
© The Author(s). 2017