V Dinesh Kumar, R Rajprasath, Priyadharshini N A, Murugan Magi, Devi Rema
Department of Anatomy, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.
Department of Anatomy, Pondicherry Institute of Medical Sciences, Puducherry, India.
Anat Cell Biol. 2020 Jun 30;53(2):151-161. doi: 10.5115/acb.19.199.
The clinical reasoning skills is often gained when the biomedical knowledge is broadened and deepened alongside exposure to patients. The 'ideal' blend of axioms of clinical reasoning and case based learning would establish the pedagogical bridges right from the first year of medical education. So this study aimed to investigate the perceived importance and efficacy of teaching clinical reasoning skills among first year medical students, as this has not previously been described. As a priori, two clinical reasoning skill sessions were conducted using clinico-anatomical case vignettes designed according to the literature regarding clinical reasoning ('serial cue' approach and hypothetico-deduction). Students were divided into intervention and control group and crossed over in subsequent sessions. Analysis was done by mixed method approach including measuring proof of benefit using post-test comparison, quantitative survey and qualitative analysis by nominal group discussion. Post test scores were compared using student's -test. Feedbacks were analysed using descriptive statistics. The results showed that post test scores were significantly higher in intervention group than the control group in both sessions (<0.001, 0.016). A total of 66% students felt, diagnostic skills and lateral thinking abilities were improved and It helped in developing problem-solving abilities for 67% students. clinico-anatomical case vignettes helped in understanding anatomical basis of clinical conditions for 61% students. To conclude, introducing clinical reasoning has considerable effect in improving the decision making ability of the students and if incorporated right from the first year, would better prepare the students in successful transition to clinical learning environment.
临床推理技能通常是在生物医学知识随着接触患者而得到拓宽和深化的过程中获得的。临床推理公理与基于案例的学习的“理想”融合将从医学教育的第一年就搭建起教学桥梁。因此，本研究旨在调查一年级医学生对临床推理技能教学的感知重要性和有效性，因为此前尚未对此进行过描述。先验地，使用根据有关临床推理的文献（“系列线索”方法和假设演绎法）设计的临床解剖学病例 vignettes 进行了两次临床推理技能课程。学生被分为干预组和对照组，并在随后的课程中交叉。采用混合方法进行分析，包括通过后测比较测量益处证明、定量调查和通过名义小组讨论进行定性分析。使用学生 t 检验比较后测分数。使用描述性统计分析反馈。结果表明，在两个课程中，干预组的后测分数均显著高于对照组（<0.001，0.016）。共有 66% 的学生认为诊断技能和横向思维能力得到了提高，67% 的学生认为这有助于培养解决问题的能力。临床解剖学病例 vignettes 帮助 61% 的学生理解临床病症的解剖学基础。总之，引入临床推理对提高学生的决策能力有相当大的影响，如果从第一年就纳入，将更好地帮助学生成功过渡到临床学习环境。
