Clinical reasoning has been defined in a general sense as “the thinking and decision-making processes associated with clinical practice” or even more simply “diagnostic problem solving” (Higgs and Jones, 2000 and Elstein, 1995). Clinical reasoning means different things to different individuals, but for the purposes of the new CUSOM Trek curriculum, we settled on a definition of clinical reasoning as the ability of students “to sort through a cluster of features presented by a patient and accurately assign a diagnostic label, with the development of an appropriate treatment strategy being the end goal” (Eva, 2005). Clinical reasoning conceptualized in this way can be deconstructed into seven discreet domains that allow for alignment of teaching materials and assessment tools in the Trek curriculum.
In the Plains, early clinical reasoning sessions will focus on introducing the vocabulary and fundamental concepts. Diagnostic schemas (flowcharts of diagnostic possibilities centered around a chief concern) of common conditions framed around prototypical clinical cases discussed in basic medical science coursework will help link basic science knowledge to the clinical reasoning, communication, and physical examination skills taught in the clinical skills (DOCS) course. Early case-based clinical reasoning sessions will highlight aspects of information gathering from the history and physical examination as well as aspects of hypothesis generation and problem representation. Consistent practice with oral presentations and medical documentation will be one way that the development of a differential diagnosis, a leading diagnosis, diagnostic justifications, and management and treatment plans will be taught in the clinical reasoning sessions. Students will be assessed using a combination of workplace-based assessments in their preceptorship, non-workplace-based assessments, and objective structured clinical examinations (OSCE) during the Plains pre-clerkship phase. The assessment data will be organized around the seven domains of clinical reasoning and sample broadly across a variety of clinical content areas. This student clinical reasoning performance data in the Plains will be linked to other data across clinical experiences in the Foothills clerkship phase and Alpine-Summit post-clerkship phase to provide a programmatic understanding of clinical reasoning performance in the Trek curriculum.