Purpose Diagnostic errors contribute to patient safety risks, often arising from cognitive failures in clinical reasoning. Preceptorship is thought to improve residents’ clinical reasoning. The aim of this study was to evaluate the effect of a preceptorship program on clinical reasoning among pediatric residents.
Methods This randomized controlled trial was conducted from March 2025 to May 2025 at Dr. Soetomo General Academic Hospital, Surabaya, Indonesia. All pediatric residents were randomly allocated into two groups. The intervention group received a scheduled preceptorship program, while the control group continued with standard supervision. After 8 weeks, clinical reasoning skills were assessed using the Script Concordance Test (SCT). Data were analyzed using comparation test. End-of-program questionnaires were also reported.
Results Total 41 residents completed the study. Baseline characteristics did not differ between groups (p>0.05). Mean overall SCT scores ranged from 55% to 90% of the maximum possible score. Among 14 topics, hematology & oncology was the only topic that showed a significant difference in SCT scores between the intervention group (median, 14.28; interquartile range [IQR], 12.78–15.08) and the control group (median, 12.75; IQR, 11.49–13.63). Participants reported that preceptorship made learning more structured and interactive but noted barriers including busy preceptor schedules and lack of standardized teaching materials.
Conclusion The preceptorship program resulted in a significant improvement in only one topic, which may reflect suboptimal implementation of the intervention. Despite this, participants reported positive perceptions, indicating good acceptability. More intensive and consistent preceptorship may be required to achieve measurable improvements in clinical reasoning.
This scoping review describes the responsibilities of facilitators, especially clinical teachers, in facilitating clinical reasoning and factors affecting the implementation of the strategies. This review was conducted by collecting and identifying original data in peer-reviewed full English journals published between 2004 and 2021. It followed Arksey and O’Malley’s framework and adhered to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines. The process included formulating review questions, developing a comprehensive search strategy, selecting relevant studies, extracting data, and presenting findings. Initial searches were conducted on PubMed, EBSCO, Scopus, and EMBASE, with a research librarian ensuring the efficiency and comprehensiveness of the search. The search based on the PCC approach (population, concept, context approach) encompassed “clinical reasoning,” “facilitation,” and “clinical teachers.” Out of the initial 2,004 records retrieved from the four databases, a thorough screening process led to the 30 studies included in the review, revealing three primary themes and multiple strategies related to clinical reasoning facilitation in clinical settings. These themes involved the responsibilities of clinical teachers, strategies utilized, and factors influencing clinical reasoning learning in clinical settings. In the clinical settings, clinical teachers have crucial responsibilities in facilitating clinical reasoning learning, including creating a safe environment, demonstrating effective practices, using appropriate strategies, and assessing students’ abilities. While this review has explored the responsibilities of clinical teachers, specific strategies that enhance clinical reasoning abilities need further investigation. Additionally, the impacts of identified factors on strengthening clinical reasoning abilities require more analysis.
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Purpose This study developed and implemented case-based flipped learning using illness script worksheets and investigated the responses of preclinical students and professors to the intervention in terms of its effectiveness, design, and implementation.
Methods The study was conducted at a medical school in Korea, where the “clinical reasoning method” course, originally a lecture-oriented course, was redesigned into a flipped learning. In total, 42 second-year medical students and 15 professors participated in this course. After the class, online surveys were conducted, and a focus group interview was held with seven students to explore the students’ experiences in more detail.
Results In total, 37 students and seven professors participated in the survey. The mean score for all items is 3.12/4 for the student survey and 3.43/4 for the professor survey. The focus group interview results were categorized as the beneficial aspects and challenges for the development of clinical reasoning.
Conclusion The findings indicated that their responses to the intervention were generally positive, and it is thought to be an effective instructional method for fostering clinical reasoning skills in preclinical medical students.
Clinical reasoning has been characterized as being an essential aspect of being a physician. Despite this, clinical reasoning has a variety of definitions and medical error, which is often attributed to clinical reasoning, has been reported to be a leading cause of death in the United States and abroad. Further, instructors struggle with teaching this essential ability which often does not play a significant role in the curriculum. In this article, we begin with defining clinical reasoning and then discuss four principles from the literature as well as a variety of techniques for teaching these principles to help ground an instructors’ understanding in clinical reasoning. We also tackle contemporary challenges in teaching clinical reasoning such as the integration of artificial intelligence and strategies to help with transitions in instruction (e.g., from the classroom to the clinic or from medical school to residency/registrar training) and suggest next steps for research and innovation in clinical reasoning.
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Purpose Developing clinical reasoning across the medical curriculum requires valid, reliable, and feasible assessment tools. However, few validated tools are available for the convenient and efficient quantification of clinical reasoning. Thus, this study aimed to create a shorter version of the Diagnostic Thinking Inventory (DTI) and validate it in the Korean medical education context (DTI-SK).
Methods The DTI-SK was constructed using content validity and a translation and back-translation process. It comprises two subcategories and 14 items. Its validity and reliability were explored using exploratory and confirmatory factor analyses, mean comparisons of four medical student groups (med 1 to med 4), and internal consistency using Cronbach’s α. Two hundred medical students were invited to participate through email, and the survey was administered for 2 weeks.
Results Data from 136 students were analyzed. Exploratory factor analysis revealed two factors with eigenvalues greater than 1.0 and they together explained 54.65% of the variance. Confirmatory factor analysis demonstrated that the model had acceptable level of fit and convergent validity. Discriminant validity was confirmed using heterotrait-monotrait criterion. Group comparisons demonstrated that the med 4 students showed significantly higher scores than the med 1 and 2 students. The inventory exhibited strong internal consistency for all items (Cronbach’s α=0.906).
Conclusion The findings indicated that the DTI-SK is a reliable and valid tool for measuring medical students’ clinical reasoning in the context of Korean medical education.
Purpose The development of students’ clinical reasoning skills should be a consideration in the design of instruction and evaluation in medical education. In response to the coronavirus disease 2019 (COVID-19) pandemic, several changes in the medical curriculum have been implemented in promoting clinical reasoning. This study aims to explore medical students’ perceptions and experiences with the clinical reasoning curriculum during the COVID-19 pandemic and determine their skills development.
Methods The study used a mixed-method design with a concurrent approach. A cross-sectional study was conducted to compare and examine the relationship between the outcomes of the structured oral examination (SOE) and the Diagnostic Thinking Inventory (DTI). Then, the qualitative method was used. A focus group discussion using a semi-structured interview guide with open-ended questions was conducted, then the verbatim transcript was subjected to thematic analysis.
Results There is an increase in SOE and DTI scores between second-year to fourth-year students. The diagnostic thinking domains and SOE are significantly correlated (r=0.302, 0.313, and 0.241 with p<0.05). The three primary themes from the qualitative analysis are perceptions regarding clinical reasoning, clinical reasoning activities, and the learning component.
Conclusion Even if students are still studying throughout the COVID-19 pandemic, their clinical reasoning skills can improve. The clinical reasoning and diagnostic thinking skills of medical students increase as the length of the school year increases. Online case-based learning and assessment support the development of clinical reasoning skills. The skills are supported in their development by positive attitudes toward faculty, peers, case type, and prior knowledge.
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Clinical reasoning training in the pre-clinical phase has recently been considered important; however, when it comes to specific instructional methods for pre-clinical students, much is unknown. Thus, the aim of this review is to explore learning and teaching methods for pre-clinical students’ clinical reasoning development based on illness script formation, their results, and strategies. A systematic review was conducted in accordance with the guidelines of the Association for Medical Education in Europe. The literature search was performed using the Cochrane Library, PubMed, EMBASE, Web of Science, and ERIC databases based on keywords, including “illness script*” AND (“medical student*” OR pre-clinical OR undergraduate). Then, 10 studies among the 91 studies were included in the final analysis. The quality of the selected studies was also appraised using the Medical Education Research Study Quality Instrument. Diverse teaching and learning methods were used to support the integration of biomedical and clinical knowledge working with patient cases, and their effects were assessed through diverse methods, including illness script richness and maturity, to learner responses. The effects of these interventions were effective in terms of the clinical reasoning development of pre-clinical students. Learning and teaching strategies were synthesized and described. This review found that explicit attempts to promote illness script formation with a structured program rather than informal training lead to positive results, and such formal clinical reasoning programs can provide smooth transition from pre-clinical to clinical experience.
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Clinical reasoning is considered a crucial concept in reaching medical decisions. This paper reviews the reasoning processes involved in clinical reasoning from the perspective of cognitive psychology. To properly use clinical reasoning, one requires not only domain knowledge but also structural knowledge, such as critical thinking skills. In this paper, two types of reasoning process required for critical thinking are discussed: inductive and deductive. Inductive and deductive reasoning processes have different features and are generally appropriate for different types of tasks. Numerous studies have suggested that experts tend to use inductive reasoning while novices tend to use deductive reasoning. However, even experts sometimes use deductive reasoning when facing challenging and unfamiliar problems. In clinical reasoning, expert physicians generally use inductive reasoning with a holistic viewpoint based on a full understanding of content knowledge in most cases. Such a problem-solving process appears as a type of recognition-primed decision making only in experienced physicians’ clinical reasoning. However, they also use deductive reasoning when distinct patterns of illness are not recognized. Therefore, medical schools should pursue problem-based learning by providing students with various opportunities to develop the critical thinking skills required for problem solving in a holistic manner.
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