Clinical Reasoning in Undergraduate Primary Care Medical Education: An International Systematic Review

Problem

Students learn clinical reasoning for decision making in many settings including in the primary care practice. But, the implications of the primary care setting as an environment to teach and learning clinical reasoning is unclear. To our knowledge, this is the first study conducted on clinical reasoning teaching and learning in the undergraduate primary care practice setting. We designed a systematic review to identify and describe the educational activities, barriers to and facilitators for clinical reasoning teaching and learning in undergraduate medical education.

Approach

Using the BEME Systematic Review Guideline; empirical studies in English and Malay Languages were selected using a predetermined inclusion and exclusion criteria through searches in the MEDLINE, PsychINFO, EMBASE, CINAHL, ERIC databases and grey literature.

Findings

An initial scoping search using the key search terms of “clinical reasoning in medical education” in the PubMed database yielded 1583 articles of interest. With the help of an information specialist, a specific search strategy using a combination of expanded MESH terminologies and individual keyword resulted in 814 from a combination of databases i.e. EMBASE. MEDLINE and Psych INFO. Following deduplication, the numbers were reduced to 699 titles. Third scoping using the final consensus terminologies from MEDLINE yielded 313 titles. We reviewed all the abstracts and estimated that approximately 30% of full-text articles are relevant to the review questions. We anticipated this number will double when we include other databases. In the next three months, we will extract and analyse the findings using narrative synthesis. Themes are coded in the areas of clinical reasoning teaching and learning activities, conceptual framework underlying the clinical reasoning education, issues in implementations, facilitators and barriers characteristics, as well as outcomes particularly regarding students’ experiences and roles and experiences of stakeholders.

Consequences

Curriculum developers and clinical teachers may benefit from this review from the typology of the clinical reasoning education practised globally. It can guide clinical reasoning module design and development in the primary care setting. Gap for future research recommendation will also be highlighted.