Directed Teaching of Clinical Reasoning in the Fourth Year of Medical School: A Structured Summary of Genetic Observations

Abstract

INTRODUCTION: Clinical reasoning (CR) encompasses diagnostic activity, treatment planning, execution, and monitoring, as well as prognosis establishment. It is a skill that needs to be taught rather than left to chance. Clinical rotations provide an ideal learning environment for CR. AIM: To evaluate a directed teaching (DT) approach for CR learning, using structured summary of observation (SSO), based on a known case during a genetics rotation for fourth-year medical students (MS4). METHODS: This was a longitudinal, descriptive study involving MS4 on a genetics rotation during the first semester of the 2020/2021 academic year. Three DT sessions were conducted, focusing on the development of SSOs to teach Down syndrome, Turner syndrome, DiGeorge syndrome, and fragile X syndrome. The pedagogical approach was evaluated based on the grades assigned to the SSOs, a comparison of pre- and post-test averages, calculation of the relative gain for the average grades of the three DT sessions, calculation of the Cohen's d effect size, and calculation of the heterogeneity rate. Student evaluation of the teaching approach was done through a satisfaction questionnaire. RESULTS: Forty-nine students divided into 10 groups of four to six students participated in three DT sessions. The average grade for the SSOs was 14.12 [10.75-16.5] (p=0.15). The average grade for the pre-tests was 9.3 [7.16-11.23] (p=0.13), and for the post-tests, it was 13.22 [11.93-14.59] (p=0.034). The relative gain for the average grades of the three DT sessions was 35.81% [10.9-65.78]. The heterogeneity rate was 21.98% for the pre-test averages and 12.6% for the post-test averages. The Cohen's d effect size was 2.06. Analysis of the student satisfaction questionnaire showed that the overall appreciation of the DT sessions was very satisfactory in 85% of cases. CONCLUSION: DT for genetic diseases using SSOs had a positive effect on the acquisition of new theoretical knowledge in the short term. This active learning method was well-received by the majority of students.