RSD: seasoning for Clinical Reasoning

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:

  1. Students struggling with Case Based Learning can benefit from an explicit but non-linear conceptualisation of clinical reasoning.
  2. 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).
  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.
  4. 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?

Author: johnwillison

Senior Leturer, Discipline of Higher Education, School of Education, University of Adelaide.

4 thoughts on “RSD: seasoning for Clinical Reasoning”

  1. Hi John
    it’s great to read that you can see the synergy between the RSD and clinical reasoning in the med course. This is has been our experience in oral health, where we have adapted the RSD (via the Sue Bandaranaike inspired WSB framework) to come up with our Clinical Reflective Skills framework. We have tweaked it a bit around the edges,and I rather like the reasoning (as oppposed to reflective) title.
    Would be keen to discuss more -as I think we still need to wordksmith out version inthe BcatOH
    Cathy

    1. Hi Cathy

      Happy to discuss more when you get a chance.

      It was a really strong synergy. Now that I have run the session, the impressive thing was that their first case had mapped onto Level 1 (Prescribed Clinical Reasoning) of the RSD and their third case mapped onto Level 2 (Bounded Clinical Reasoning). This suggests that the Uni Adelaide Medical Curriculum was moving them progressively towards increased autonomy. Present in the session was Andrew, a sixth year medical student; he commented that their cases back in his first year were far less structured, and that they struggled far more. He characterised their early cases as Level 3 (Scaffolded Clinical Reasoning). Its really tempting now to use the RSD to map the existing Case Base Learning and compare it to the original Problem Based Learning of 6 years ago. I know of at least one other medical program that was planning to use the RSD for that mapping.

      John

  2. Hi guys
    I also love the the idea of using the RSD in a clinical reasoning context for case based learning and clinical practice across the health professions. I can see how useful it would be for students to have a framework that could guide their approach when undertaking the process of differential diagnosis and treatment planning. However, I wouldn’t be keen to change our ‘reflective’ term to ‘reasoning’ in our CRS rubric, as I believe reasoning is only one part of reflective practice, a key part of course. As an example, students need to exercise sound clinical reasoning skills when making decisions about a patient’s diagnosis, treatment plan and treatment outcome. However, being able to analyse how effective they have been as practitioners in executing these clinical reasoning skills requires them to be able to critically analyse their current knowledge, skills, attitudes and behaviours and develop evidenced based approaches to constantly improve on these. Hence why I believe that Clinical Reasoning Skills needs to be a part of Clinical Reflective Skills. Hope this makes sense!
    Sophie

    1. Hi Sophie

      It does. We have to use terminology that fits the context. For your Second Year students, I think that they are begining to see clearly the connection between research skills and clinical reflection, because you have made that connection explicit. Lucky them! No wonder your students have such good research and clinical outcomes, evident at the end of the degree and a year into practice.

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