Department of Health Sciences, Lund University, P.O. Box 157, SE-221 00, Lund, Sweden.
Faculty of Medicine Centre for Teaching and Learning, Lund University, P.O. Box 157, SE-221 00, Lund, Sweden.
BMC Med Educ. 2017 Sep 11;17(1):158. doi: 10.1186/s12909-017-1002-4.
Outcome- or competency-based education is well established in medical and health sciences education. Curricula are based on courses where students develop their competences and assessment is also usually course-based. Clinical reasoning is an important competence, and the aim of this study was to monitor and describe students' progression in professional clinical reasoning skills during health sciences education using observations of group discussions following the case method.
In this qualitative study students from three different health education programmes were observed while discussing clinical cases in a modified Harvard case method session. A rubric with four dimensions - problem-solving process, disciplinary knowledge, character of discussion and communication - was used as an observational tool to identify clinical reasoning. A deductive content analysis was performed.
The results revealed the students' transition over time from reasoning based strictly on theoretical knowledge to reasoning ability characterized by clinical considerations and experiences. Students who were approaching the end of their education immediately identified the most important problem and then focused on this in their discussion. Practice knowledge increased over time, which was seen as progression in the use of professional language, concepts, terms and the use of prior clinical experience. The character of the discussion evolved from theoretical considerations early in the education to clinical reasoning in later years. Communication within the groups was supportive and conducted with a professional tone.
Our observations revealed progression in several aspects of students' clinical reasoning skills on a group level in their discussions of clinical cases. We suggest that the case method can be a useful tool in assessing quality in health sciences education.
基于成果或能力的教育在医学和健康科学教育中已经得到广泛应用。课程基于学生发展能力的课程，评估通常也基于课程。临床推理是一项重要的能力，本研究旨在通过观察基于案例的小组讨论来监测和描述学生在健康科学教育中专业临床推理技能的进展。
在这项定性研究中，观察了来自三个不同健康教育计划的学生，他们在哈佛案例法的改良版课程中讨论临床案例。使用了一个包含四个维度的评分表 - 解决问题的过程、学科知识、讨论的特点和沟通 - 作为观察工具来识别临床推理。采用了演绎内容分析法。
结果揭示了学生随着时间的推移从严格基于理论知识的推理过渡到以临床考虑和经验为特征的推理能力。即将完成学业的学生立即确定了最重要的问题，然后在讨论中集中讨论这个问题。实践知识随着时间的推移而增加，这被视为专业语言、概念、术语的使用和先前临床经验的使用的进步。讨论的特点从教育早期的理论考虑发展到后期的临床推理。小组内的沟通是支持性的，并以专业的语气进行。
我们的观察表明，学生在小组讨论临床案例时，在临床推理技能的几个方面都有了进展。我们建议案例法可以成为评估健康科学教育质量的有用工具。
