Comparative analyses of knowledge, attitude and practice of medical undergraduates and early career doctors about the use of clinical reasoning as a tool for medical diagnosis and management

Abstract

Introduction: Developing the skills of clinical reasoning is a tedious process, especially for the novice learner and requires practice. The clinical reasoning skill is a cognitive process of systematic clinical decision making needed to reduce diagnostic errors. A clinical reasoning tool for diagnosis using the Bloom’s taxonomy of critical thinking has been in use in the Paediatrics Department of the University of Port Harcourt. However, little is known about the difficulties encountered by trainees (medical students and early career doctors) while using the tool during daily
clinical clerkship. We aimed to determine aspects of the clinical reasoning process trainees find difficult and ways to make this easier.

Methods: A well-structured, pretested questionnaire was administered to 67 medical undergraduates and 99 early career medical doctors which assessed responses to the definition of clinical reasoning, matching Bloom’s taxonomy hierarchy with steps in clinical reasoning, functional and
structural abnormalities and attitudes towards the use of the clinical reasoning tool. The Likert 5 point scale tool was used to assess attitudes and practice difficulties during the use of the tool. The differences in responses were tested for significance using Student’s T test, and Chi squared test,
with p values <0.05 as significant.

Results: Of the 166 respondents analysed, 103 (62%) got the correct definition of clinical reasoning with early career doctors having a higher  proportion of correct respondents, χ2 = 4.59, p = 0.032. Specific areas of difficulties identified were with making clinical diagnosis in 50 (30.1%) and pathologic diagnosis (es) in 38 (22.9%). Ninety-nine (59.6%) responded that clinical reasoning was time consuming and 42 (25.3%) thought it was difficult to practice in a busy clinic. One hundred and six (64.1%) respondents suggested a view of basic clinical studies before starting clinical   practice in order to improve clinical reasoning.

Conclusion/Recommendation: Making clinical diagnosis is difficult for the clinical trainee while using the clinical reasoning tool, therefore the  clinical teacher should help trainees move from one cognitive level to the next until the trainee can create logical conclusions from information gathered following clerking.

Keywords: Clinical reasoning, critical thinking, medical students, interns