The development of clinical reasoning skills by medical students

http://www.ncbi.nlm.nih.gov/pubmed/21785314

Acad Med. 2011 Jul 21. [Epub ahead of print]
Tracking Development of Clinical Reasoning Ability Across Five Medical Schools Using a Progress Test.
Williams RG, Klamen DL, White CB, Petrusa E, Fincher RM, Whitfield CF, Shatzer JH, McCarty T, Miller BM.
Source
Dr. Williams is J. Roland Folse Professor of Surgical Education Emeritus, Department of Surgery, Southern Illinois University School of Medicine, Springfield, Illinois. Dr. Klamen is associate dean for education and curriculum and professor, Department of Medical Education, Southern Illinois University School of Medicine, Springfield, Illinois. Dr. White is associate dean for faculty development and educational achievement, Medical College of Georgia School of Medicine, Augusta, Georgia. Dr. Petrusa is director, Office for Teaching and Learning in Medicine, director, Center for Outcomes Research in Education, and professor of medical education and administration, Vanderbilt School of Medicine, Nashville, Tennessee. Dr. Fincher is professor, Department of Medicine, and vice dean for academic affairs and codirector, Education Discovery Institute, Medical College of Georgia School of Medicine, Augusta, Georgia. Dr. Whitfield is associate dean for preclinical curriculum, Penn State College of Medicine, Hershey, Pennsylvania. Dr. Shatzer is director, Center for Experiential Learning and Assessment, and associate professor of medical education and administration, Vanderbilt School of Medicine, Nashville, Tennessee. Dr. McCarty is associate professor, Department of Psychiatry, and assistant dean, Simulation and Assessment, University of New Mexico School of Medicine, Albuquerque, New Mexico. Dr. Miller is senior associate dean for health sciences education, Vanderbilt School of Medicine, Nashville, Tennessee.

Abstract
PURPOSE:
Little is known about the acquisition of clinical reasoning skills in medical school, the development of clinical reasoning over the medical curriculum as a whole, and the impact of various curricular methodologies on these skills. This study investigated (1) whether there are differences in clinical reasoning skills between learners at different years of medical school, and (2) whether there are differences in performance between students at schools with various curricular methodologies.

METHOD:
Students (n = 2,394) who had completed zero to three years of medical school at five U.S. medical schools participated in a cross-sectional study in 2008. Students took the same diagnostic pattern recognition (DPR) and clinical data interpretation (CDI) tests. Percent correct scores were used to determine performance differences. Data from all schools and students at all levels were aggregated for further analysis.

RESULTS:
Student performance increased substantially as a result of each year of training. Gains in DPR and CDI performance during the third year of medical school were not as great as in previous years across the five schools. CDI performance and performance gains were lower than DPR performance and gains. Performance gains attributable to training at each of the participating medical schools were more similar than different.

CONCLUSIONS:
Years of training accounted for most of the variation in DPR and CDI performance. As a rule, students at higher training levels performed better on both tests, though the expected larger gains during the third year of medical school did not materialize.