Lim Jun Jie, Veasuvalingam Bhavani
School of Medicine and Population Health, University of Sheffield, Sheffield, UK.
Faculty of Medical Sciences, Newcastle University Medicine Malaysia, Iskandar Puteri, Johor, Malaysia.
Future Healthc J. 2024 Nov 13;12(1):100210. doi: 10.1016/j.fhj.2024.100210. eCollection 2025 Mar.
Blended learning, integrating face-to-face and virtual methods, has become essential in clinical education, enhancing student satisfaction, engagement and knowledge outcomes. Particularly, online case-based learning emerges as a promising pedagogy to foster clinical reasoning skills. Despite the well-documented clinical reasoning cultivation through face-to-face case-based learning, the ability of online case-based learning to cultivate clinical reasoning remains unexplored. This study investigates the role of online case-based learning in fostering clinical reasoning skills among clinical-year medical students.
A mixed-methods sequential explanatory research study was adopted. In the first phase, quantitative data were gathered through a 16-item Likert scale questionnaire adapted from validated clinical reasoning questionnaires. In the second phase, focus group discussions were conducted to expand on the understanding of quantitative results.
In total, 160 students completed the questionnaire (45% response rate), and 26 participated in focus group discussions. Participants agreed that online case-based learning fostered clinical reasoning skills (mean = 2.94) through different formats, such as clinical role play, simulated ward rounds and virtual consultation. Compared to face-to-face clinical teaching, the focus group revealed that participants were allowed to practise giving explanations to patients, engage in more in-depth discussions, and receive more comprehensive feedback on their clinical reasoning skills during online case-based learning. The barriers to online clinical reasoning skills development were poorer communication skills development and reduced student engagement. The lack of patient complexities of cases and the inability to perform physical examinations hindered students' clinical reasoning ability. Suggestions to improve clinical reasoning cultivation include utilising actual patient cases, increasing case complexity and session interactivity.
This study highlights how online case-based learning can support the development of clinical reasoning skills in medical students, encouraging future educators to adopt a blended learning approach. Future research should focus on objective assessments, long-term impacts and innovative methods to improve clinical reasoning skill development continuously.
混合式学习将面对面教学与虚拟教学方法相结合，已成为临床教育的重要组成部分，可提高学生满意度、参与度并提升知识学习成果。特别是，基于案例的在线学习已成为培养临床推理能力的一种很有前景的教学方法。尽管通过面对面的基于案例的学习培养临床推理能力已有充分的文献记载，但基于案例的在线学习培养临床推理能力的效果仍有待探索。本研究调查了基于案例的在线学习在培养临床医学生临床推理能力方面的作用。
采用混合方法序列解释性研究。在第一阶段，通过一份从经过验证的临床推理问卷改编而来的16项李克特量表问卷收集定量数据。在第二阶段，进行焦点小组讨论以加深对定量结果的理解。
共有160名学生完成了问卷（回复率为45%），26名学生参与了焦点小组讨论。参与者一致认为，基于案例的在线学习通过临床角色扮演、模拟查房和虚拟会诊等不同形式培养了临床推理能力（平均分为2.94）。与面对面临床教学相比，焦点小组发现，在基于案例的在线学习过程中，参与者能够练习向患者解释病情，进行更深入的讨论，并获得关于其临床推理能力更全面的反馈。在线临床推理能力发展的障碍包括沟通技能发展较差和学生参与度降低。病例缺乏患者复杂性以及无法进行体格检查阻碍了学生的临床推理能力。提高临床推理培养的建议包括使用实际患者病例、增加病例复杂性和课程互动性。
本研究强调了基于案例的在线学习如何支持医学生临床推理能力的发展，鼓励未来的教育工作者采用混合式学习方法。未来的研究应侧重于客观评估、长期影响以及创新方法，以持续改进临床推理能力的发展。
