On Monday, I am working with 160 First Year medical students for two hours, five weeks into their Case Based Learning (a variation of PBL) curriculum. The theme is making more explicit the processes around clinical reasoning, and focusing on underlying mechanisms.
I was a little surprised when I ran a session for these same students in Week 2 of their six-year degree, and introduced facets of clinical reasoning using a scenario; the surprise for me was how effectively the six facets of the RSD (Research Skill Development framework: see www.rsd.edu.au) framed the reasoning needed in a clinical context. So, on Monday, I am introducing them to the CRD- Clinical Reasoning Development framework, which is the RSD retitled, and with descriptions of their current medical scenario lined up with each of the six facets. This case seems to fit neatly with ‘Level 2: Bounded Reasoning, where boundaries set by and limited directions from educator channel student reasoning.’ I will also show the students how the first case they completed several weeks ago lines up with ‘Level 1: Prescribed Reasoning, where highly structured directions and modelling from educators prompt student reasoning’.
The advantages of this approach to making resoning processes explicit seem to be substantial:
- Students struggling with Case Based Learning can benefit from an explicit but non-linear conceptualisation of clinical reasoning.
- It maps out where students were working conceptually early on in the course (Level 1), where they are currently working (Level 2), and especially where they will be required to work in the immediate future (Level 3).
- As these levels (five in total) of the RSD describe ‘degrees of autonony’, the students develop a sense of the need to be working increasingly autonomously in clinical contexts. This is vital if they are to be effective doctors making decisions on wards, in practices and in other environments.
- The medical curriculum has requirements to incorporate more research components, and if the same six facets are used for Clinical Reasoning Development and Research Skill Development, then there is a natural segue between these overlapping, but nuanced cognitive skill sets. This means that students see explicitly that developing the skills pertaining to clinical reasoning also develops the skills associated with researching in medical contexts. This connection is frequently not clear or intuitive: having ‘sister frameworks’ of CRD and RSD make the connection obvious.
So, on Monday I will again sprinkle the six facets of the RSD as cognitive seasoning to further medical students clinical reasoning.
What have you done to develop clinical reasoning with students who are struggling with the process?