Tufts Medical Center, Boston, MA, USA.
Maine Medical Center, Portland, ME, USA.
J Gen Intern Med. 2017 Nov;32(11):1242-1246. doi: 10.1007/s11606-017-4159-y. Epub 2017 Aug 24.
Recent reports, including the Institute of Medicine's Improving Diagnosis in Health Care, highlight the pervasiveness and underappreciated harm of diagnostic error, and recommend enhancing health care professional education in diagnostic reasoning. However, little is known about clinical reasoning curricula at US medical schools.
To describe clinical reasoning curricula at US medical schools and to determine the attitudes of internal medicine clerkship directors toward teaching of clinical reasoning.
Cross-sectional multicenter study.
US institutional members of the Clerkship Directors in Internal Medicine (CDIM).
Examined responses to a survey that was emailed in May 2015 to CDIM institutional representatives, who reported on their medical school's clinical reasoning curriculum.
The response rate was 74% (91/123). Most respondents reported that a structured curriculum in clinical reasoning should be taught in all phases of medical education, including the preclinical years (64/85; 75%), clinical clerkships (76/87; 87%), and the fourth year (75/88; 85%), and that more curricular time should be devoted to the topic. Respondents indicated that most students enter the clerkship with only poor (25/85; 29%) to fair (47/85; 55%) knowledge of key clinical reasoning concepts. Most institutions (52/91; 57%) surveyed lacked sessions dedicated to these topics. Lack of curricular time (59/67, 88%) and faculty expertise in teaching these concepts (53/76, 69%) were identified as barriers.
Internal medicine clerkship directors believe that clinical reasoning should be taught throughout the 4 years of medical school, with the greatest emphasis in the clinical years. However, only a minority reported having teaching sessions devoted to clinical reasoning, citing a lack of curricular time and faculty expertise as the largest barriers. Our findings suggest that additional institutional and national resources should be dedicated to developing clinical reasoning curricula to improve diagnostic accuracy and reduce diagnostic error.
最近的报告，包括医学研究所的《改善医疗保健中的诊断》，强调了诊断错误的普遍性和被低估的危害，并建议加强医疗保健专业人员在诊断推理方面的教育。然而，对于美国医学院的临床推理课程知之甚少。
描述美国医学院的临床推理课程，并确定内科住院医师主任对临床推理教学的态度。
横断面多中心研究。
内科住院医师主任（CDIM）的美国机构成员。
调查了 2015 年 5 月向 CDIM 机构代表发送的电子邮件调查的回复，他们报告了自己医学院的临床推理课程情况。
回复率为 74%（91/123）。大多数受访者报告说，应该在医学教育的所有阶段教授临床推理的结构化课程，包括基础医学年（64/85；75%）、临床实习（76/87；87%）和第四年（75/88；85%），并且应该投入更多的课程时间来讨论这个话题。受访者表示，大多数学生在进入实习阶段时，对关键临床推理概念的了解仅为较差（25/85；29%）至一般（47/85；55%）。大多数接受调查的机构（52/91；57%）缺乏专门针对这些主题的课程。缺乏课程时间（59/67，88%）和教师在教授这些概念方面的专业知识（53/76，69%）被认为是障碍。
内科住院医师主任认为临床推理应该在医学教育的 4 年中教授，重点是临床年。然而，只有少数人报告说有专门的临床推理教学课程，他们指出缺乏课程时间和教师专业知识是最大的障碍。我们的研究结果表明，应该投入更多的机构和国家资源来开发临床推理课程，以提高诊断准确性和减少诊断错误。
