Barriers to Learning Clinical Reasoning: a Qualitative Study of Medicine Clerkship Students
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ORIGINAL RESEARCH
Barriers to Learning Clinical Reasoning: a Qualitative Study of Medicine Clerkship Students Nicholas Duca 1
&
Nancy Adams 2 & Susan Glod 1 & Paul Haidet 1
# International Association of Medical Science Educators 2020
Abstract Clinical reasoning is crucial to good patient care, but both learning and applying clinical reasoning skills in the context of a complex working environment can be challenging. We sought to understand the perceived barriers to learning clinical reasoning, as experienced by internal medicine clerkship students at our institution. We invited internal medicine clerkship students to participate in focus groups to discuss their experiences with and barriers to learning clinical reasoning. A survey was administered to gather additional responses. Responses were reviewed, coded, and synthesized to identify key themes. Twenty-nine medicine clerkship students (male = 14, female = 15) participated in six 60-minute focus groups, and 121 (61% response rate) students responded to the barriers to clinical reasoning survey from March 2018 to May 2019. We identified three themes (clerkship acclimation, data access, and practice optimization) and ten subthemes as aspects of the clerkship environment that impacted students’ ability to develop clinical reasoning skills. Students identified barriers to learning clinical reasoning during the internal medicine clerkship. The themes “clerkship acclimation” and “data access” were identified as prerequisites to clinical reasoning while the theme “practice optimization” described key components of the deliberate practice of clinical reasoning. Educators and health systems may improve the development of clinical reasoning by recognizing and overcoming these barriers within clinical learning environments. Keywords Clinical reasoning . Medical student . Qualitative . Clerkship
Introduction Clinical reasoning is the complex process of thinking that drives diagnosis and treatment decisions and is a core competency in medical education [1, 2]. In 2015, the National Academies of Sciences, Engineering, and Medicine released the publication “Improving Diagnosis in Health Care” calling for increased awareness and prevention of diagnostic error [3]. Since then, clinical reasoning education has become an emerging field [4]. Multiple classroom-based clinical reasoning curricula exist in both undergraduate and graduate medical education [5–7]. Given the importance of the deliberate practice of clinical reasoning in real-world settings, there remains a need for * Nicholas Duca [email protected]
workplace-based teaching and assessment of clinical reasoning [8, 9]. However, interactions within a particular learning environment can help or hinder student development [10–12]. Fully understanding the interaction among students, teachers, and the workplace is necessary to optimize students’ learning of clinical reasoning. Previous studies have utilized the student’s perspective to identify barriers to teaching evidencebased medicine and clinical reasoni
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