Implementation of an educational exercise to enhance clinical reasoning in third year medical students

Clinical reasoning (CR) is essential to a physician's practice of medicine. Although there have clear efforts to incorporate CR into the pre-clinical curriculum at UCSD-SOM, there is a lack of formal CR education during rotations. Thus, the Clinical Reasoning Exercise (CRE) was designed for third year medical students on the inpatient internal medicine service. The CRE is an educational exercise that provides step-by-step guidance through the diagnostic process by utilizing three principles--problem representation, diagnostic schema, and illness scrips. Supplementary materials include narrated PowerPoint/YouTube tutorials (for both students and faculty) as well as an example completed CRE for student reference. The CRE was piloted with six students rotating the Veteran's Association (VA) in February 2019. Students were met in small groups (2-3) to review general aspects and logistics. After the one-month long inpatient rotation, students were sent the link to an anonymous survey. The overall respondent rate was 66% (N=4/6). All four students reported completing one CRE during the 4-week block. Overall, students felt the CRE was a useful exercise that helped educate them on CR/CR principles and helped them systematically approach a clinical problem. However, there was a mixed response as to whether the CRE should be implemented in the future curriculum. The students' main concerns included increasing the number of requirements for the rotation and redundancy with a pre-existing requirement. Going forward, the CRE itself will need to be modified and its position in the curriculum closely reassessed. In addition, a larger sample size is needed to adequately obtain generalizability to the remainder of the third-year class