Themes & Learning outcomes
The following sections show the categories and the overarching learning objectives for the DID-ACT student curriculum and the train-the-trainer course (TTT). References to published learning objectives are indicated by the numbers in brackets (see references).
Upon completion of the course:
(1) Theories of clinical reasoning
1.1 The student will have an understanding of key theoretical models related to clinical reasoning. (1,2,3,5)
(2) Gathering, interpreting, and synthesizing patient information
2.1 The student will be competent in gathering, interpreting, and synthesizing patient information. (1, 6, 10)
2.2 The student will be able to accurately and efficiently collect key clinical findings needed for the analysis of a patient’s problem. (11)
2.3 The student will be able to accurately and efficiently analyze and interpret the key clinical findings to plan patient treatment and care. (7)
(3) Generating differential diagnoses including defining and discriminating features
3.1 The student will be competent in generating differential diagnoses including defining and discriminating features. (1, 7, 9)
3.2 The student will be competent in identifying the most likely diagnoses/problems/treatments based on the interpretation and prioritization of different patient-relevant information. (1, 10, 11)
3.3 The student will know about benefits and risks of clinical decision support systems, including artificial intelligence, in clinical reasoning. (11)
(4) Developing a treatment/management plan
4.1 The student will be competent in developing treatment/management plans.
4.2 The student will be able to apply treatment, therapeutic and prophylactic procedures based on a holistic assessment of the patient, the diagnosis, the healthcare context, alongside with current best evidence.
4.3 The student will know how to set treatment goals together with the patient based on evidence, healthcare context and the patient’s needs and preferences. (6, 7)
(5) Aspects of patient participation in clinical reasoning
5.1 The student will be competent in involving the patient in clinical reasoning. (7)
5.2 The student will be able to engage and collaborate with patients and families, in accordance with their values and preferences in the diagnosis and analysis of a patient’s problems. (7, 11)
5.3 The student will be able to involve and support the patient in a shared decision-making process about the treatment/management plan. (1)
5.4 The learner will be able to appreciate the patient’s (including his/her relatives) roles in clinical reasoning.
(6) Collaborative aspects of clinical reasoning
6.1 The student will be competent in collaborating with others in the clinical reasoning process. (6)
6.2 The student will be able to make use of other team members’ (own and other professions) competencies regarding patient information, diagnostic and treatment/management. (4)
(7) Interprofessional aspects of clinical reasoning
7.1 The student will be competent in applying interprofessional aspects of clinical reasoning.
7.2 The student will be able to collaborate and communicate across professions in the clinical reasoning process to meet the needs of the patient. (4, 11)
7.3 The student will understand how personal, professional and interprofessional values affect interprofessional care. (1)
7.4 The student will understand similarities and differences between the clinical reasoning of health professions.
(8) (Interprofessional) Collaboration and exchange (TTT)
8.1 The learner will be competent in teaching about similarities, differences, and most common sources of errors and biases in the clinical reasoning process of health professions.
(9) Ethical aspects
9.1 The student will be able to take legal, moral, diversity, gender-related, and ethical aspects into account in the clinical reasoning process.
(10) Self-reflection on clinical reasoning performance and strategies for future improvement
10.1 The student will be competent in applying self-reflection on clinical reasoning performance and develop strategies for future improvement.
10.2 The student will know how to use self-reflection and clinical critical thinking to improve diagnostic, therapeutic and management performance. (11)
10.3 The student will be able to evaluate the outcomes of the clinical reasoning with patients and colleagues and plan for appropriate improvements together with patients and colleagues.
(11) Errors in the clinical reasoning process and strategies to avoid them
11.1 The student will have an understanding of common cognitive errors and biases in the clinical reasoning process and be able to apply strategies to avoid them. (1, 2, 3, 5, 7, 8, 9, 12)
11.2 The student will have an understanding of the benefits of an open climate which allows sharing of errors for promoting continuous learning and patient safety. (11, 12)
11.3 The student will be able to explain the occurrence of uncertainty in the clinical reasoning process under different circumstances and how to deal with them in a safe manner. (1, 8)
11.4 The student will have an understanding of how cognitive biases, system issues, and emotions can influence clinical reasoning. (12)
11.5 The student will know how to overcome common challenges and errors during the clinical reasoning process. (1)
(12) Attitudes towards clinical reasoning teaching (TTT)
12.1 The learner will be able to critically reflect on the importance of clinical reasoning learning, teaching, and assessment.
12.2 The learner will develop an awareness and openness to share errors in the clinical reasoning teaching.
12.3 The learner will be motivated and inspired to teach and assess clinical reasoning
(13) Teaching, assessing, and evaluating clinical reasoning (TTT)
13.1 The learner will be able to choose appropriate teaching, assessment and evaluation methods for clinical reasoning and adapt these to the cultural context. (5)
13.2 The learner will be able to implement the DID-ACT clinical reasoning student curriculum into their teaching.
(14) Decision Making
14.1 Students will be competent in making diagnostic decisions based on hypotheses regarding the patient’s problem.
14.2 Students will be competent in making management decisions taking the patient’s goals and perceived situation into account.
14.3 Students will be competent in re-evaluating their decisions based on new information.
- O’Connor et al., Chapter 32 in book: Higgs, J. (2019) Clinical Reasoning in Health Professions
- Duca NS, Glod S. Bridging the gap between the classroom and the clerkship: a clinical reasoning curriculum for third-year medical students. MedEdPORTAL. 2019;15:10800.
- Weinstein A, Gupta S, Pinto-Powell R, et al. Diagnosing and remediating clinical reasoning difficulties: a faculty development workshop. MedEdPORTAL. 2017;13:10650.
- Stephenson, R. C. (2004). Using a complexity model of human behaviour to help interprofessional clinical reasoning. International Journal of Therapy and Rehabilitation, 11(4), 168-175.
- Iyer S, Goss E, Browder C, Paccione G, Arnsten J. Development and evaluation of a clinical reasoning curriculum as part of an Internal Medicine Residency Program. Diagnosis (Berl). 2019;6(2):115-119
- Liou SR, Liu HC, Tsai HM, et al. The development and psychometric testing of a theory-based instrument to evaluate nurses’ perception of clinical reasoning competence. J Adv Nurs. 2016;72(3):707-717.
- Polish Ministry of Science and Higher Education Educational Outcomes for Medicine Catalogue (Directive 2019; 1573)
- Harendza S, Krenz I, Klinge A, Wendt U, Janneck M. Implementation of a Clinical Reasoning Course in the Internal Medicine trimester of the final year of undergraduate medical training and its effect on students’ case presentation and differential diagnostic skills. GMS J Med Educ. 2017;34(5):Doc66.
- NKLM (National competency-based learning objectives catalog, in German)
- Olson A, Rencic J, Cosby K, Rusz D, Papa F, Croskerry P, et al. Competencies for improving diagnosis: an interprofessional framework for education and training in health care. Diagnosis. 2019;6(4):335–41.
- Kiesewetter J et al. The Learning Objective Catalogue for Patient Safety in Undergraduate Medical Education – A Position Statement of the Committee for Patient Safety and Error Management of the German Association for Medical Education. GMS J Med Educ. 2016; 33(1): Doc10