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The student is key: a realist review of educational interventions to develop analytical and non-analytical clinical reasoning ability

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journal contribution
posted on 02.04.2020, 08:45 by Anna Richmond, Nicola Cooper, Simon Gay, William Atiomo, Rakesh Patel
BACKGROUND:Clinical reasoning refers to the cognitive processes used by individuals as they formulate a diagnosis or treatment plan. Clinical reasoning is dependent on formal and experiential knowledge. Developing the ability to acquire and recall knowledge effectively for both analytical and non-analytical cognitive processing has patient safety implications. This realist review examines the way educational interventions develop analytical and non-analytical reasoning ability in undergraduate education. A realist review is theory-driven, seeking not only to identify if an intervention works, but also understand the reasons why, for whom, and in what circumstances. AIM:To develop understanding about the way educational interventions develop effective analytical and non-analytical clinical reasoning ability, when they do, for whom and in what circumstances. METHODS:Literature from a scoping search, combined with expert opinion and researcher experience was synthesised to generate an initial programme theory (IPT). Four databases were searched and articles relevant to the developing theory were selected as appropriate. Factors affecting educational outcomes at the individual student, teacher and wider organisational levels were investigated in order to further refine the IPT. RESULTS:28 papers contributed to the overall programme theory. The review predominantly identified evidence of mechanisms for interventions at the individual student level. Key student level factors influencing the effectiveness of interventions included an individual's self-confidence, self-efficacy and pre-existing level of knowledge. These contexts influenced a variety of educational interventions, impacting both positively and negatively on educational outcomes. DISCUSSION:Development of analytical and non-analytical clinical reasoning ability requires activities that enhance knowledge acquisition and recall alongside the accumulation of clinical experience and opportunities to practise reasoning in real or simulated clinical environments. However, factors such as pre-existing knowledge and self-confidence influence their effectiveness, especially among individuals with 'low knowledge'. Promoting non-analytical reasoning once novices acquire more clinical knowledge is important for the development of clinical reasoning in undergraduate education.

History

Citation

Medical Education, 2020

Author affiliation

School of Medicine

Version

AM (Accepted Manuscript)

Published in

Medical Education

Publisher

Wiley for Association for the Study of Medical Education

issn

0308-0110

eissn

1365-2923

Copyright date

2020

Publisher version

https://onlinelibrary.wiley.com/doi/10.1111/medu.14137

Spatial coverage

England

Language

eng

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