Perspectives on the current state of pre-clerkship clinical reasoning instruction in United States medical schools: a survey of clinical skills course directors
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Shanu Gupta
,
Jennifer M. Jackson
Abstract
Objectives
Clinical reasoning skills are essential for sound medical decision-making. Though many have suggested that clinical reasoning instruction should begin in pre-clerkship curricula, neither pre-clerkship clinical skills director perspectives nor extent of instruction is known. This survey study serves as part of a needs assessment for United States medical school pre-clerkship clinical reasoning curricula.
Methods
United States medical school pre-clerkship clinical skills course directors were surveyed about perceived importance of formal instruction on clinical reasoning concepts, inclusion of these concepts in the curricula, barriers to instruction, and familiarity with clerkship curricula. Results were analyzed using descriptive and analytic statistics. Narrative comments were analyzed qualitatively for themes.
Results
Of 148 directors surveyed, 102 (69%) participated and 89 (60%) completed all closed-ended items. Each clinical reasoning concept was identified as somewhat to extremely important to include in pre-clerkship curricula by 90–99% of respondents. Pre-clerkship curricula included variable degrees of formal instruction for concepts, though most respondents rated their inclusion as moderate or extensive. Perceived importance of teaching most concepts moderately correlated with the degree of inclusion in the curriculum (Spearman’s rho 0.39–0.44). Curricular time constraints and lack of faculty with skills to teach these concepts were the most frequently cited barriers to instruction. Respondents indicated being somewhat 57% (n=54) to extremely 29% (n=27) familiar with clerkship curricula at their institutions.
Conclusions
This study is the first to examine pre-clerkship clinical skills course director perspectives about clinical reasoning instruction and extent of its inclusion in their curricula.
Acknowledgments
The authors wish to thank their collaborators from the ACE clinical reasoning group who co-developed the parallel surveys. The authors also wish to thank Drs. Joseph Rencic and Robert Trowbridge for their collaboration and review of the survey, the DOCS Executive Committee for its review of the survey and approval for distribution to DOCS members, and Drs. Jorie Colbert-Getz and Boyd Richards for their survey design expertise. Finally, the authors thank the DOCS members who participated in this survey study.
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Research funding: None declared.
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Author contributions: Shanu Gupta contributed significantly to study design, survey development, data collection and interpretation, overall manuscript drafting especially of the discussion and conclusions, and final preparation for submission. Jennifer M. Jackson contributed significantly to study design, survey development, data collection and interpretation, overall manuscript drafting especially of the abstract and relationship of findings to existing literature, and final preparation for submission. Joel Appel contributed significantly to study design, survey development, data collection and interpretation, overall manuscript drafting especially of the introduction and discussion, and final preparation for submission. Robin Ovitsh contributed significantly to study design, survey development, data collection and interpretation, overall manuscript drafting especially of the introduction and relationship to existing literature, and final preparation for submission. Sandra Oza contributed significantly to study design, survey development, data collection and interpretation, overall manuscript drafting especially of the discussion and conclusions, and final preparation for submission. Roshini Pinto-Powell contributed significantly to study design, survey development, data collection and interpretation, overall manuscript drafting especially of the introduction and discussion, and final preparation for submission. Candace Chow contributed significantly to survey review, quantitative and qualitative data analysis and interpretation, overall manuscript drafting especially of the results and relationship to existing literature, and final preparation for submission. Danielle Roussel contributed significantly to study design, survey development, data collection and interpretation, overall manuscript drafting especially of the methods and results, and final preparation for submission. All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
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Competing interests: Authors state no conflict of interest.
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Informed consent: Informed consent was obtained from all individuals included in this study.
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Ethical approval: This study was reviewed and deemed exempt by the Institutional Review Boards at Michigan State University (STUDY00001255), Dartmouth College (STUDY00032024), and the University of Utah (IRB00127650).
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Supplementary Material
The online version of this article offers supplementary material (https://doi.org/10.1515/dx-2021-0016).
© 2021 Walter de Gruyter GmbH, Berlin/Boston
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