We concluded that the clinical reasoning skills of fourth-year medical students benefited from this training course, and the lower correction of the most likely diagnosis rate found with abdominal pain, anemia, and fever might be due to a system-based teaching modules in fourth-year medical students cross-system remedial reasoning auxiliary training is recommended for fourth-year medical students in the future.ĭifferential diagnosis is important for clinicians and involves a deeper higher order thinking process about the evaluation of history taking, physical examination, review of laboratory data, and diagnostic images that exceed memorization, facts, and concepts. The post-study questionnaire results indicated significant satisfaction with the teaching program (4.7/5) and the quality of teacher feedback (4.9/5). We found a correlation in the clinical reasoning process between the correct and incorrect most likely diagnosis groups (group history-taking score, p = 0.045 key information number, p = 0.009 and diagnosis number, p = 0.004). The abdominal pain scenario yielded even worse results (history taking: 2.9/5 and clinical reasoning 2.7/5). The scenario of anemia presented the most difficult challenge for students in history taking (3.5/5) and clinical reasoning (3.5/5). Standardized patients presenting with abdominal pain (8.3%) and anemia (18.2%) had the lowest diagnosis rates. The average history-taking score was 64%, the average key information number was 7, the average diagnosis number was 1.1, and the average correct diagnosis rate was 38%. ResultsĪ total of 76 students, five teachers, and five standardized patients participated in this clinical reasoning training activity. Residents were trained to act as teachers, and a post-study questionnaire was employed to evaluate the students’ satisfaction with the training activity. A group history-taking with individual reasoning principles was implemented to teach and evaluate students’ abilities to take histories, document key information, and arrive at the most likely diagnosis. We created five patient scenarios for our standardized patients, including hemoptysis, abdominal pain, fever, anemia, and chest pain. In this study, we designed a teaching activity to evaluate the clinical reasoning competence of fourth-year medical students. The process of clinical reasoning includes history taking, physical examinations, validating medical records, and determining a final diagnosis.
The most important factor in evaluating a physician’s competence is strong clinical reasoning ability, leading to correct principal diagnoses.