A skill-based clinical reasoning curriculum for clerkship-level medical students: a randomized and controlled study

BACKGROUND: A 2015 IOM report highlighted the urgent need for better training in medical decision‐making. Despite this, a recent national survey reported that up to 57% of medical schools lack formal education dedicated to clinical reasoning. We sought to determine if formalized instruction in clinical reasoning through use of an innovative multi‐modal curriculum is an effective means of improving clinical reasoning skills in third year medical students. METHODS: We conducted a randomized and controlled experiment to evaluate the impact of this curriculum on clinical reasoning knowledge and skills in third year medical students at a single allopathic U.S. medical school. Students in the intervention group completed interactive online modules focused on clinical reasoning concepts and participated in a skills‐based workshop. Students in the control group participated in standard educational experiences. We assessed the impact of the curriculum on clinical reasoning knowledge, skills, and perceptions of students' own education according to the following metrics: 1. Performance on a 20‐item quiz about clinical reasoning concepts at the conclusion of the 4‐week intervention period; 2. Clinical reasoning skills through blinded scoring of weekly student hospital admission notes using a validated clinical reasoning assessment tool; 3. Perception of students' own education using a Likert scale. Comparisons between control and intervention group were conducted using a t‐test for independent samples. RESULTS: In total, 67 students participated from whom we received a total of 250 hospital admission notes. Students in the intervention group demonstrated superior performance on the 20‐item clinical reasoning quiz (67% correct vs. 54%, p < 0.05). Admission notes from the intervention group received significantly higher average ratings for data synthesis (2.3 vs. 2.0 on a 3‐point scale, p < 0.05) and for diagnostic reasoning (2.2 vs. 1.9, p < 0.05), while average scores for data gathering, reporting, and decision‐making did not differ. Students in the intervention group reported more frequent use of clinical reasoning terminology and more explicit discussion of clinical reasoning by their attending physicians. CONCLUSION: Exposure to our innovative multi‐modal curriculum was associated with improved knowledge regarding clinical reasoning concepts and superior written demonstration of clinical reasoning skills in 3rd year medical students. Thus, interactive online modules paired with opportunity for skills practice is an effective and efficient means of delivering clinical reasoning education. Our student survey responses suggest that participation in such experiences may prime students to identify demonstration of clinical reasoning by clinical role models, thus providing a scaffolding for development of medical decision‐making skills in the clinical setting.