Abstract
Objectives
Published clinical reasoning curricula are limited, and measuring curricular impact has proven difficult. This study aims to evaluate the impact of a broad-reaching, multi-level reasoning curricula by measuring utilization of clinical reasoning terminology in published abstracts.
Methods
In 2014, the University of Pittsburgh Medical Center (UPMC) created a clinical reasoning curriculum with interventions at the student, resident, and faculty levels with the goal of bringing reasoning education to the forefront. This study was a retrospective analysis of published clinical vignettes of the Society of General Internal Medicine prior to local curricular intervention (2014), post-curricular intervention (2018), and on follow-up (2022). UPMC-affiliated abstracts were compared to abstracts containing reasoning terms from all other institutions, at each time point.
Results
There was a statistically significant increase in the use of clinical reasoning terms by UPMC-affiliated participants from 2014 to 2018. Non-UPMC submissions, saw a smaller, but still significant increase in the use of clinical reasoning terms. There was a decline in clinical reasoning term use from 2018 to 2022, both at UPMC and nationally.
Conclusions
This study demonstrates that widespread clinical reasoning curricula can increase interest in and use of clinical reasoning terminology. Further work is needed to develop creative assessment tools for reasoning curricula.
Funding source: The University of Pittsburgh General Internal Medicine Fellow Research Fund
Award Identifier / Grant number: n/a
-
Research ethics: Not applicable.
-
Informed consent: Not applicable.
-
Author contribution: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
-
Use of Large Language Models, AI and Machine Learning Tools: None declared.
-
Conflict of interest: The authors state no conflict of interest.
-
Research funding: The University of Pittsburgh General Internal Medicine Fellow Research Fund.
-
Data availability: Not applicable.
References
1. Balogh, E, Miller, BT, Ball, J, Institute of Medicine (U.S.). Committee on diagnostic error in health care. In: Improving diagnosis in health care quality chasm series. xxvii: The National Academies Press; 2015:444 p.10.17226/21794Search in Google Scholar PubMed
2. Functions and structure of a medical school: standards for accreditation of medical education programs leading to the MD degree. Liason committee on medical education; 2023:14–24 pp. https://lcme.org/publications/.Search in Google Scholar
3. Internal medicine milestones. 2020.Search in Google Scholar
4. Lambe, KA, O’Reilly, G, Kelly, BD, Curristan, S. Dual-process cognitive interventions to enhance diagnostic reasoning: a systematic review. BMJ Qual Saf 2016;25:808–20. https://doi.org/10.1136/bmjqs-2015-004417.Search in Google Scholar PubMed
5. DiNardo, D, Bonifacino, E, Tilstra, S, McNeil, M, Painter, T, Tabas, G, et al.. Listening to reasoning: strategies for instilling a culture of clinical reasoning. Pennsylvania Patient Safety Authority 2018;15:51–2.Search in Google Scholar
6. Egloff, HM, West, CP, Wang, AT, Lowe, KM, Edakkanambeth Varayil, J, Beckman, TJ, et al.. Publication rates of abstracts presented at the society of general internal medicine annual meeting. J Gen Intern Med 2017:673–8. https://doi.org/10.1007/s11606-017-3990-5.Search in Google Scholar PubMed PubMed Central
7. Abstracts from the 37th Annual Meeting of the Society of General Internal Medicine. J Gen Intern Med. 2014;29:1–545, San Diego, CA, USA. https://doi.org/10.1007/s11606-014-2834-9 Search in Google Scholar PubMed PubMed Central
8. Scientific Abstracts. J Gen Intern Med 2018;33:88–840. https://doi.org/10.1007/s11606-018-4413-y.Search in Google Scholar
9. Abstracts from the 2022 Annual Meeting of the Society of General Internal Medicine. J Gen Intern Med 2022;37:S129–664.10.1007/s11606-022-07653-8Search in Google Scholar
10. Musgrove, JL, Morris, J, Estrada, CA, Kraemer, RR. Clinical reasoning terms included in clinical problem solving exercises? J Grad Med Educ 2016;8:180–4. https://doi.org/10.4300/JGME-D-15-00411.1.Search in Google Scholar PubMed PubMed Central
© 2024 Walter de Gruyter GmbH, Berlin/Boston
Articles in the same Issue
- Frontmatter
- Reviews
- Accuracy of pulse wave velocity for screening coronary artery disease: a systematic review and meta-analysis
- Prenatal screening for genetic disorders: updated guidelines, proposed counseling, a holistic approach for primary health care providers in developing countries
- A scoping review of fever of unknown origin with normal serum C-reactive protein
- Mini Review
- Overview of dengue diagnostic limitations and potential strategies for improvement
- Opinion Papers
- Demystifying cognitive bias in the diagnostic process for frontline clinicians and educators; new words for old ideas
- Physicians’ prism: illuminating history with structured expertise
- Original Articles
- Implementation of a curriculum on communicating diagnostic uncertainty for clerkship-level medical students: a pseudorandomized and controlled study
- A synthesized differential diagnosis is associated with fewer diagnostic errors compared to an inventorial list
- Equity-Driven Diagnostic Excellence framework: An upstream approach to minimize risk of diagnostic inequity
- Two decades of autopsy-detected diagnostic errors in Japan
- Does management reasoning display context specificity? An exploration of sleep loss and other distracting situational (contextual) factors in clinical reasoning
- Cognitive biases in osteopathic diagnosis: a mixed study among French osteopaths
- Racial and ethnic disparities in pediatric emergency department patients with missed opportunities for diagnostic excellence
- Diagnostic accuracy of non-mydriatic fundus photography as a triage and telemedicine tool for patients with vision loss
- “Innumerable” lesion burden on brain MRI ‒ a diagnostic approach
- Factors associated with positive findings of deep infection on computed tomography among patients with extremity cellulitis
- Exploring emergency department providers’ uncertainty in neurological clinical reasoning
- Analytical performance and user-friendliness of four point-of-care measuring systems for monitoring prothrombin time international normalized ratio in the hands of the intended users
- Fetal hematological phenotypes of various hemoglobinopathies and demonstration of embryonic hemoglobins on capillary electrophoresis: a large cohort data from prenatal screening program
- Development and assessment of autoverification system for routine coagulation assays in inpatient and outpatient settings of tertiary care hospital: algorithm performance and impact on laboratory efficiency
- Validation of new, circulating biomarkers for gliomas
- Short Communications
- Using language to evaluate curricular impact: a novel approach in assessing clinical reasoning curricula
- Comparative evaluation of routine coagulation testing on Stago sthemO 301 and Werfen ACL TOP 750
- Letters to the Editor
- Reversible systemic vasoconstriction syndrome: a new diagnostic family of generalized vasospasm in multiple organs
- The value of designating symptoms as “vague” in diagnosis
- Immunoglobulin E in an inverted skin-prick test for rapid detection of cutaneous antigens
Articles in the same Issue
- Frontmatter
- Reviews
- Accuracy of pulse wave velocity for screening coronary artery disease: a systematic review and meta-analysis
- Prenatal screening for genetic disorders: updated guidelines, proposed counseling, a holistic approach for primary health care providers in developing countries
- A scoping review of fever of unknown origin with normal serum C-reactive protein
- Mini Review
- Overview of dengue diagnostic limitations and potential strategies for improvement
- Opinion Papers
- Demystifying cognitive bias in the diagnostic process for frontline clinicians and educators; new words for old ideas
- Physicians’ prism: illuminating history with structured expertise
- Original Articles
- Implementation of a curriculum on communicating diagnostic uncertainty for clerkship-level medical students: a pseudorandomized and controlled study
- A synthesized differential diagnosis is associated with fewer diagnostic errors compared to an inventorial list
- Equity-Driven Diagnostic Excellence framework: An upstream approach to minimize risk of diagnostic inequity
- Two decades of autopsy-detected diagnostic errors in Japan
- Does management reasoning display context specificity? An exploration of sleep loss and other distracting situational (contextual) factors in clinical reasoning
- Cognitive biases in osteopathic diagnosis: a mixed study among French osteopaths
- Racial and ethnic disparities in pediatric emergency department patients with missed opportunities for diagnostic excellence
- Diagnostic accuracy of non-mydriatic fundus photography as a triage and telemedicine tool for patients with vision loss
- “Innumerable” lesion burden on brain MRI ‒ a diagnostic approach
- Factors associated with positive findings of deep infection on computed tomography among patients with extremity cellulitis
- Exploring emergency department providers’ uncertainty in neurological clinical reasoning
- Analytical performance and user-friendliness of four point-of-care measuring systems for monitoring prothrombin time international normalized ratio in the hands of the intended users
- Fetal hematological phenotypes of various hemoglobinopathies and demonstration of embryonic hemoglobins on capillary electrophoresis: a large cohort data from prenatal screening program
- Development and assessment of autoverification system for routine coagulation assays in inpatient and outpatient settings of tertiary care hospital: algorithm performance and impact on laboratory efficiency
- Validation of new, circulating biomarkers for gliomas
- Short Communications
- Using language to evaluate curricular impact: a novel approach in assessing clinical reasoning curricula
- Comparative evaluation of routine coagulation testing on Stago sthemO 301 and Werfen ACL TOP 750
- Letters to the Editor
- Reversible systemic vasoconstriction syndrome: a new diagnostic family of generalized vasospasm in multiple organs
- The value of designating symptoms as “vague” in diagnosis
- Immunoglobulin E in an inverted skin-prick test for rapid detection of cutaneous antigens