KeyLIME 89: Clinical Reasoning and the Clinician Educator

The Key Literature in Medical Education podcast tackles a hot topic in #meded right now – clinical reasoning (aka diagnostic error).

I should acknowledge my conflict of interest up front, as I conduct research in this area and have opinions that at times are at odds with some established perspectives.  Putting this aside, the podcast this week examines a paper that provides one approach to introducing “clinical reasoning” into a curriculum.  Of course, with any hot topic there will be controversies.  (Check out the podcast to see where Linda, Jason and I argue!) However, there are also some helpful pearls for the CE considering incorporating this content area into their program.

For a quick overview of the paper, the abstract is below.  For more details,
download the podcast here.

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KeyLIME Session 89 – Article under review:

Fri post_KeyLIME

Listen to the podcast

View/download the abstract here.

Cutrer WB1, Sullivan WM2, Fleming AE3. Educational strategies for improving clinical reasoning. Current Problems in Pediatrics and Adolescent Health Care. 2013 Oct;43(9):248-57.

Reviewer: Jason Frank

Background
Clinical reasoning, the expert process of gathering, processing, and using data to make clinical decisions, is clearly a fundamental aspect of medical education. While there is a significant body of literature (full of raging debates), there is no definitive guide on how to teach clinical reasoning. Enter this 2013 paper by Cutrer, Sullivan, & Fleming in a Peds journal.

Purpose
Cutrer et al set out to summarize the world’s literature on clinical reasoning, through the lens of teaching strategies for educators.

Type of paper
Narrative review

Key Points on the Methods
None. Nada. No idea how they came to settle on these points.

Key Outcomes
The major value of this paper lies in a clever and somewhat eclectic assembly of tools for teaching clinical reasoning to novice learners. While I disagree with some of the statements about the underlying psychology in some parts, this is a very useful collection.

Their key tips can be summarized as follows:
KeyLIME 89
Spare Keys – other take home points for clinician educators
Key Conclusions
The authors conclude teaching clinical reasoning is hard, so teachers must use techniques as these to really be impactful.

As I said, this is a clever, albeit somewhat random, collection of helpful teaching tips. All clinical teachers should have this in their library.

I disagree with their statement that research suggests System 2 thinking is more accurate. The opposite is true of experts. The goal is to teach exemplars to get novices to see the patterns and heuristics.

Clinician-educators should familiarize themselves with some of the big-name authors referred to in the text (e.g. Schon, Kahneman, Pangaro).

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