Implementing A Clinical Reasoning Curriculum for Pediatrics Residents: A Pilot Study

Abstract

Clinical reasoning is a complex entity that has been described as a cognitive and non-cognitive process by which a health care professional consciously and unconsciously interacts with the patient and environment to collect and interpret patient data, weigh the benefits and risks of actions, and understand patient preferences to determine a working diagnostic and therapeutic management plan whose purpose is to improve a patient’s well-being1. This concept has been a focus of medical education efforts in hopes of fostering master clinicians and ultimately improving patient outcomes by reducing diagnostic errors (which have an estimated incidence of 10 to 20%)2-4. Clinical reasoning curricula, though more prevalent in undergraduate medical education, have begun to emerge in graduate medical education programs with promising results demonstrating improvement in validated clinical reasoning metrics.5-8 However, almost all of this work has been in the field of internal medicine. Given the parallel breadth of disease states and changing physiology pediatricians face, and a greater than 60% misdiagnosis rate for certain pediatrics conditions, there is a need for a similar curriculum development efforts in pediatrics residencies to improve the diagnostic reasoning ability of future pediatricians.9

A pilot study, looking at the early implementation of a clinical reasoning curriculum for pediatrics residents at IU, was conducted in summer 2023. The overall objective of this developing curriculum is to improve pediatric residents’ clinical reasoning knowledge and skills. The first goal was to better understand the baseline perceptions and knowledge of clinical reasoning. A needs assessment was conducted via administration of voluntary, anonymous, electronic survey that was emailed to all combined and categorical pediatrics residents. These results suggested an unmet need in regards to clinical reasoning education for pediatrics trainees. Thus two one hour lectures, modeled off of the ACP’s Teaching Clinical Reasoning text, were given to residents during scheduled noon conference timeslots. The first lecture defined clinical reasoning, discussed the impact of diagnostic error, and modeled a framework to label and access diagnostic reasoning techniques. The second lecture took place one week later and consisted of five interactive cases that allowed the group to practice clinical reasoning in different settings (classroom/case conferences, bedside, teacher, team leader, remediating a learner). 7 residents attended both sessions and were participants in this pilot study, completing both a pre and post survey. Though not powered for statistical significance, there was a trend towards enhanced perception on the importance of clinical reasoning and improved performance on knowledge questions. This suggests that implementing an expanded longitudinal clinical reasoning curriculum within the pediatrics residency could enhance clinical reasoning understanding and ability.