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Am J Med. 2017 Sep;130(9):1113.e1-1113.e8. doi: 10.1016/j.amjmed.2017.03.050. Epub 2017 Apr 26.

How Exemplary Inpatient Teaching Physicians Foster Clinical Reasoning.

Author information

1
Medicine Service, VA Ann Arbor Healthcare System, Mich; Department of Internal Medicine, University of Michigan Medical School, Ann Arbor. Electronic address: nathanho@med.umich.edu.
2
Veterans Affairs (VA) Center for Clinical Management Research, VA Ann Arbor Healthcare System, Mich.
3
Department of English and Sweetland Center for Writing, University of Michigan, Ann Arbor.
4
Medicine Service, VA Ann Arbor Healthcare System, Mich; Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; Veterans Affairs (VA) Center for Clinical Management Research, VA Ann Arbor Healthcare System, Mich.

Abstract

BACKGROUND:

Clinical reasoning is a crucial component of training in health professions. These cognitive skills are necessary to provide quality care and avoid diagnostic error. Much previous literature has focused on teaching clinical reasoning in nonclinical environments and does not include learner reflections. The authors sought to explore, through multiple perspectives including learners, techniques used by exemplary inpatient clinician-educators for explicitly cultivating clinical reasoning.

METHODS:

The authors conducted (2014-2015) a multisite, exploratory qualitative study examining how excellent clinician-educators foster clinical reasoning during general medicine rounds. This was accomplished through interviews of educators, focus group discussions with learners, and direct observations of clinical teaching. The authors reviewed field notes and transcripts using techniques of thematic analysis.

RESULTS:

Twelve clinician-educators, 57 current learners, and 26 former learners participated in observations and interviews. The techniques and behaviors of educators were categorized into 4 themes, including 1) emphasizing organization and prioritization, 2) accessing prior knowledge, 3) thinking aloud, and 4) analyzing the literature.

CONCLUSIONS:

The findings of this comprehensive study both confirm strategies found in previous literature and provide novel approaches. This is the first study to incorporate the perspectives of learners. Educators' techniques and behaviors, identified through direct observation and supported by reflections from the entire team, can inform best practices for the teaching of clinical reasoning.

KEYWORDS:

Attending physicians; Clinical reasoning; Clinical teaching; Inpatient rounds; Medical education

PMID:
28454903
DOI:
10.1016/j.amjmed.2017.03.050
[Indexed for MEDLINE]

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