The Pedagogy of Teaching and Assessing Clinical Reasoning for Enhancing the Professional Competence: A Systematic Review

摘要

Clinical reasoning (CR) is considered to foster clinical practice and competence. However, very few faculty development programs are available that can enhance the faculty's expertize in this innovative educational strategy. This study aims at elaborating the core concepts of teaching and assessing CR that can equip medical faculty with the desired knowledge and competence. The databases of ISI web of knowledge, MEDLINE, the Cochrane Library, and EBSCO were searched for the full-text English-language articles published during 2000 to 2015 using Medical Subject Headings (MeSH) keywords "Clinical reasoning" AND "Meta-cognitive" OR "Flipped classroom" OR "Work-place based assessment" OR "Clinical competence" OR "Experiential learning" AND "Debrief". Initial search showed 771 articles. Further search on the bibliographic list and exclusion of non-relevant material finalized 58 articles for this systematic review. The body of literature has shown that teaching CR challenges the learner to manage a given case by data acquisition, diagnostic solutions, and dual processing of information in an integrated and cohesive learning environment. Several educational strategies are employed: metacognition, deliberate practice, experiential learning, and clinical debrief using a flipped classroom model in a blended learning approach. Due to multi-dimensional and context-specific characteristics of CR, Assessment of this domain is challenging. Several assessment tools such as multiple choice and extended matching questions, script concordance test, long case examination, mini-CEX, and portfolios are shown to have the desired reliability and validity to assess CR skills. Literature has shown an encouraging trend towards the faculty acquisition of clinical reasoning skills that requires careful scaffolding of this domain throughout the curriculum. A myriad of instructional strategies and assessment modalities are used in developing CR skills. Faculty development programs should train the faculty in enhancing the desired expertize for teaching and assessing CR skills.