Implementation of a clinical reasoning curriculum for clerkship-level medical students: a pseudo-randomized and controlled study
Implementation of a clinical reasoning curriculum for clerkship-level medical students: a pseudo-randomized and controlled study
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DOI：
10.1515/dx-2018-0063
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发表时间：
2019-06-01
期刊：
影响因子：
3.5
通讯作者：
DiNardo, Deborah J.
中科院分区：
文献类型：
--
作者：
Bonifacino, Eliana;Follansbee, William P.;DiNardo, Deborah J.
背景资料：美国国家科学院的报告，提高医疗诊断强调需要更好的培训，在医疗决策，但大多数医学院缺乏正规的教育，在临床reasoning.Methods：我们进行了一个伪随机对照研究，以评估临床推理课程的影响，在内科实习。干预组的学生完成了六个互动的在线模块，重点是推理概念和技能为基础的研讨会。我们评估了课程对临床推理知识和技能的影响，并通过评估：（1）临床推理概念测验的表现，（2）住院记录中的推理演示，（3）主治医生利用临床推理概念的意识。干预组学生在临床推理知识测验中表现出上级表现（67% vs. 54%，p < 0.001）。干预组学生在数据综合方面表现出上级的书面推理能力（2.3 vs. 2.0，p = 0.02）和诊断推理（2.2 vs. 1.9，p = 0.02）部分，并报告了更多的讨论，他们的主治医生的临床推理。结论：暴露于临床推理课程与上级推理知识和上级书面演示的临床推理技能的三年级医学生的内科实习。
Background: The National Academies of Sciences report Improving Diagnosis in Healthcare highlighted the need for better training in medical decision-making, but most medical schools lack formal education in clinical reasoning.Methods: We conducted a pseudo-randomized and controlled study to evaluate the impact of a clinical reasoning curriculum in an internal medicine clerkship. Students in the intervention group completed six interactive online modules focused on reasoning concepts and a skills-based workshop. We assessed the impact of the curriculum on clinical reasoning knowledge and skills and perception of education by evaluating: (1) performance on a clinical reasoning concept quiz, (2) demonstration of reasoning in hospital admission notes, and (3) awareness of attending physician utilization of clinical reasoning concepts.Results: Students in the intervention group demonstrated superior performance on the clinical reasoning knowledge quiz (67% vs. 54%, p < 0.001). Students in the intervention group demonstrated superior written reasoning skills in the data synthesis (2.3 vs. 2.0, p = 0.02) and diagnostic reasoning (2.2 vs. 1.9, p = 0.02) portions of their admission notes, and reported more discussion of clinical reasoning by their attending physicians.Conclusions: Exposure to a clinical reasoning curriculum was associated with superior reasoning knowledge and superior written demonstration of clinical reasoning skills by third-year medical students on an internal medicine clerkship.