Clinical Reasoning Laboratory as a Part of Students’ Individual Learning Pathway

How to teach students clinical reasoning? It might seem that everything is clear on this issue. If you have studied or are studying at a medical university, you surely know what clinical reasoning is. But it’s not that simple. Medical education involves mastering a large amount of diverse theoretical material. Subsequently, the process of rationally combining all acquired knowledge to use it in the future for achieving the best clinical results becomes quite problematic. This is where clinical reasoning comes into play. The term ‘clinical reasoning’ means justification, and argumentation. Understanding the basics of clinical reasoning and being able to apply them in practice is one of the most important components of a doctor’s professional competence.

Thus, on June 17 – 21, 2024, the creative and progressive lecturers of Ternopil National Medical University Iryna Borovyk, Nataliia Haliyash, Oksana Sydorenko, and Larysa Martynyuk, who are practicing clinicians and open to intellectual volunteering, with the support of the university administration, have introduced an informal student training course called “Clinical Reasoning Laboratory.”

Future medical professionals were invited to participate in the “Laboratory,” agreeing to continue their studies in their spare time after completing semester exams. Among them were ten 4th and 5th-year students who already possess basic medical knowledge: Svitlana Mahera, Valentyna Kit, Nadiia Zarichanska, Tetiana Benediuk, Mariia Malchevska, Daryna Yuziuk, Oleksandra Lovinska, Viktoria Drahuntsova, Anastasiia Furdela, and Viktoriia Miroshnyk.

In the first session of the “Clinical Reasoning Laboratory,” we conducted five two-hour meetings. We began the training by defining the concept of critical reasoning, delved into the thinking systems proposed by Daniel Kahneman, and discussed cognitive biases. We then moved on to the basics of clinical reasoning, projected cognitive biases onto the medical field, and analyzed real clinical situations where cognitive biases hindered accurate diagnosis.

Today, in complex clinical situations in medical practice, the use of new creative problem-solving tools borrowed from business, such as the fishbone diagram (Ishikawa) and the “5 Whys” technique, is suggested.

A global trend in the development of clinical reasoning is working with virtual patients on specially designed platforms like CASUS. Free access to this platform has been provided to Ukrainian students and instructors through the “Ukraine Digital” project and Ludwig Maximilian University of Munich. This platform presents about 200 cases in Ukrainian, developed by experts from various European countries as part of the ICoVIP project (https://icovip.eu/). We invite you to register on this platform (https://player.casus.net/pmw2/app/homepage.html) using university email accounts to practice your clinical reasoning.

While mastering the CASUS training, we worked with a virtual patient who complained of a sore throat. What was unusual for the students was that the patient was not prescribed additional examination methods, and pharmacotherapy was minimal.

Another format that helps students better understand the process of clinical reasoning is analyzing a real clinical situation under the guidance of an instructor, as successfully demonstrated by Associate Professor Larysa Martynyuk. How do you transition from a woman’s complaints of significant general weakness and low blood pressure after a vacation in Egypt to diagnosing Schmidt’s syndrome? The participants had the opportunity to fully immerse themselves in this clinical quest.

In the final meeting of the session, Nataliia Haliyash discussed Clinical Case Discussion (CCD) as a student-led learning format and the main rules for preparing and presenting clinical cases.

All participants of the “Clinical Reasoning Laboratory” gained a deeper understanding of clinical reasoning, a dose of positivity, motivation, and resources, working in a team of like-minded individuals. All meetings were interactive, combining theoretical and practical components, and involving everyone in the educational process.

We concluded the first session with reflections on the event and planning the next activities within the “Clinical Reasoning Laboratory.” We plan to continue these meetings, involving students in the preparation and presentation of clinical cases, and instructors to be mentors and experts in this endeavor.

We also have ambitious plans to discuss topics such as evidence-based medicine, shared decision-making, the use of clinical calculators, working with uncertainty, pre-test and post-test probability, and more.

If clinical reasoning is also an important component of your professional activities, and you have suggestions for meeting topics, or would like to participate as a speaker, we invite you to join our team.

The information and photographs were provided by Iryna Borovyk, Nataliia Haliyash, and Oksana Sydorenko.