Teaching Clinical Reasoning – A student’s perspective

by Ada Frankowska

Hello! I’m Ada, a junior doctor from Cracow, Poland. I would like to describe how teaching clinical reasoning looks like from a student’s perspective – I just graduated university in June, so my memories are still fresh. Let’s get on with it!

At Jagiellonian University in Cracow, clinical reasoining (CR) teaching started at the second year, with the course Introduction to the Clinical Sciences and Laboratory Training in Clinical Skills.

The first course lasted a whole year. We were divided into 9-person groups, each supervised by a teacher and served with patient’s cases. The aim was for each group to manage a case to the best of their abilities – gather information, outline which lab and imaging tests would be needed, and finally how to treat the patient. We were allowed to use any books and websites we deemed necessary as this was only the second year of our studies, and all we knew were basic sciences – anatomy, physiology, biochemistry etc. The teacher was more a moderator of our discussion, trying not to impose his views and solutions on us. At the end of each class, we summarized the most important issues about each case, and where we lacked knowledge the most. At the next class, volunteers gathered necessary information about the issues and delivered a short presentation to the rest of the group. I remember this course as a nice brainstorming experience, where every idea was valid and counted.

The second course lasted four years – till the end of our studies. We were learning how to gather information from patients, be it adult, pediatric or a “poor historian”. We also were taught how to examine a patient and how to suture wounds and even the basics of laparoscopy. There was a particular emphasis placed on an ability to communicate with a patient effectively, for example how to make sure they understand us and how to deliver difficult news. During this course we also had to solve virtual patients’ cases in the CASUS system. We were evaluated by OSCE on the third and last year of our studies.

At 4th, 5th and 6th years high fidelity simulations took place. This meant we were divided into 5-person teams, with one leader, and had to take care of a simulated patient or a mannequin. We mostly dealt with emergency cases there, and the ability to see how our actions affected, for example, the patient’s blood pressure or consciousness was irreplaceable. It once more evaluated our efficacy of gathering information, but for the first time we were able to test our ability to act promptly. On the 6th year we also had an occasion to work with a nurse as a part of our team, which bettered our interdisciplinary communication. After each case we analysed our steps with the supervising teacher – what was done right and what could be done better next time.

Above all, since the 3rd year we had clinical rotations, and while the aforementioned courses really added to my knowledge, the rotations really varied in quality. Of course, there were talented teachers, and going to their classes was an enlightening experience – but there were also teachers who acted as if they lacked ideas about how to make a student an active participant in classes or at least be heard. I don’t doubt their knowledge was vast – it’s just that sometimes it was hard for them to describe their reasoning process or they didn’t feel the need to do so to us – “it’s just done like that” or “it’s in the guidelines”; not to mention that many of them didn’t even know that clinical reasoning is something that can be actively taught. This way I feel that many opportunities to learn clinical reasoning in rotations were lost.

This is why I joined the DID-ACT project – I experienced from the first-person perspective on how much could be done to better the quality of teaching at medical universities. I’m also keen on teaching myself – and when I’ll become a teacher, I want to do it the best way possible. I’ve experienced classes where the topic didn’t seem too interesting, but the teacher transformed it into something fascinating and inspiring.

With all the professionals involved and great ideas created in the DID-ACT project, I think that it’s the best place to begin a change in teaching clinical reasoning.

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