ASMEBITESIZE: Teaching Clinical Reasoning – the ‘What’, the ‘How’ and the Scholarship 

– in conjunction with CReME – the UK Clinical Reasoning in Medical Education Group

Wednesday 4th November 2020, 4:30pm

This session is made up of 2 parts - a pre-recorded video (access available below - please watch before the live session) and a live Q&A session which took place Wednesday 4th November at 4:30pm with Dr Nicola Cooper (CReME Chair), Prof Simon Gay (ASME EDC Deputy Chair & CReME Treasurer & Dr Mark Lillicrap (ASME Director from the Membership and CReME committee member)...

PART 1: Pre-recorded session 

Pre-record video access

Note: some scenes in the video were filmed before masks were mandatory in non-clinical areas in UK hospitals.

In this pre-recorded session we reflect on how, as a community of medical educators, we can deliver effective, evidence-based clinical reasoning education.

After defining what is meant by clinical reasoning, we start by considering the ‘what’ – the five key domains that the scholarship shows we need to consider when planning teaching or helping students diagnose what the issues might be:

• Clinical reasoning concepts
• History and physical examination
• Choosing and interpreting diagnostic tests
• Problem identification and management
• Shared decision making

We then introduce the six strategies of ‘how’ we can consider teaching clinical reasoning:

• Strategies that build understanding
• Strategies that employ structured reflection
• Practice with cases and corrective feedback
• Strategies that structure knowledge around problem-specific concepts
• Strategies that employ retrieval practice
• Strategies that differ according to stage of learning

We discuss ways that we have found to apply some of these principles in practice and link some of our discussions with other educational frameworks such as – reflective practice theory, experiential learning cycle, Bloom’s taxonomy, the one minute teacher/preceptor and the RIME frameworks

These are some references, that link with the presentation, that you may wish to review before the interactive Q&A session - 4^th November 16 30 – 17 30

• Daniel M, Rencic J, Durning S et al. (2019). Clinical reasoning assessment methods: a scoping review and practical guidance. Acad Med; 94(6): 902-912
• Furney S, Orsini A, Orsetti K et al. (2001). Teaching the one-minute preceptor. A randomized controlled trial. J Gen Int Med; 16(9): 620-624
• Schmidt HG & Mamede S. (2015). How to improve the teaching of clinical reasoning: a narrative review and a proposal. Medical Education; 49(10): 961–973.
• Prakash S, Sladek RM, Schuwirth L. (2019). Interventions to improve diagnostic decision making: a systematic review and meta-analysis on reflective strategies. Medical Teacher; 41(5): 517–524.
• Weinstein Y & Sumeracki M. (2019). Understanding how we learn: a visual guide. New York.

Other resources that link with the presentation:

• The RIME Framework for student evaluation – Dr Louis Pangaro: a 10 minute video introduction - https://vimeo.com/76308600
• The UK Clinical Reasoning in Medical Education Group (CReME) website resources page http://creme.org.uk/resources.html

PART 2: Live Q&A discussion – interactive session on 4^th November 2020, 4:30pm

This live session involved a facilitated discussion around how we can apply what was discussed in the pre-session video in our teaching practices, with a variety of questions addressed from the audience.

Click on the button below to access the webinar video

Video access

If you are unable to watch the video a transcript is available by clicking here

The following resources were referenced during the session:

CReME Consensus Paper on teaching clinical reasoning

CReME

Marie-Claude Audetat two part paper in MedTeach useful for educational diagnosis

Steven McGee Paper on evidence based physical analysis

ABC of Clinical Reasoning Paper

Presenters

Dr Nicola Cooper

Consultant Physician & Clinical Associate Professor in Medical Education – University of Nottingham, Chair of Crème

Professor Simon Gay

GP & Professor of Medical Education (Primary Care) – University of Leicester, ASME Educator Development Committee Deputy Chair, Treasurer of CReME

Dr Mark Lillicrap

Consultant Rheumatologist, Clinical Sub-dean (Curriculum) – University of Cambridge, ASME Board - Director from the Membership, CReME organising committee