Changes in clinical reasoning and cognitive error after a intensive
online course: A Qualitative study in medical students
Abstract
Introduction: Clinical reasoning is a crucial competence for medical
practice and also a complex task that is susceptible to cognitive
errors. It is usually taught based on whole clinical cases, from a
practical rather than from a conceptual perspective. Addressing the need
to improve clinical reasoning teaching into undergraduate medical
curricula, it was hypothesized that medical students could benefit from
a practice and theoretical approach to the clinical reasoning process.
Methods: A four week online course, based on simulation and groupal
reflective practice was developed, to promote metacognition between the
participants. The course was delivered to 8 sixth year medical students
as an elective module. A questionnaire consistent of four open-ended
questions was designed to explore knowledge about clinical reasoning and
cognitive errors, and was applied at the beginning and at the end of the
course. A qualitative analysis was conducted with Berelson content
analysis method. Results: After the course the students changed their
understanding about clinical reasoning, considering it more like a
process and identifying the dual nature described in modern theories of
clinical decision making. Also they changed their knowledge about
cognitive errors, attributing them not only to lack of knowledge, and
understanding that they can actively practice some strategies to reduce
cognitive bias. Discussion: This study confirmed that undergraduate
students change in a positive way their concept of clinical reasoning
and their knowledge about this cognitive process and cognitive errors
that occur on it after a course that includes simulation and reflection.