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Barriers to Learning Clinical Reasoning: a Qualitative Study of Medicine Clerkship Students

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Abstract

Clinical reasoning is crucial to good patient care, but both learning and applying clinical reasoning skills in the context of a complex working environment can be challenging. We sought to understand the perceived barriers to learning clinical reasoning, as experienced by internal medicine clerkship students at our institution. We invited internal medicine clerkship students to participate in focus groups to discuss their experiences with and barriers to learning clinical reasoning. A survey was administered to gather additional responses. Responses were reviewed, coded, and synthesized to identify key themes. Twenty-nine medicine clerkship students (male = 14, female = 15) participated in six 60-minute focus groups, and 121 (61% response rate) students responded to the barriers to clinical reasoning survey from March 2018 to May 2019. We identified three themes (clerkship acclimation, data access, and practice optimization) and ten subthemes as aspects of the clerkship environment that impacted students’ ability to develop clinical reasoning skills. Students identified barriers to learning clinical reasoning during the internal medicine clerkship. The themes “clerkship acclimation” and “data access” were identified as prerequisites to clinical reasoning while the theme “practice optimization” described key components of the deliberate practice of clinical reasoning. Educators and health systems may improve the development of clinical reasoning by recognizing and overcoming these barriers within clinical learning environments.

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Acknowledgments

The authors would like to acknowledge Tami Cassel for focus group transcription and the Junior Faculty Development Program of Penn State College of Medicine for supporting this research.

Availability of Data and Material

Transcripts and qualitative data will be provided at the journal’s request.

Funding

This research was funded by the Penn State College of Medicine Junior Faculty Development Program grant and the Division of General Internal Medicine Junior Faculty Development start-up grant.

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Authors and Affiliations

  1. Department of Medicine, Penn State College of Medicine, 500 University Drive H034, Hershey, PA, 17033, USA

    Nicholas Duca, Susan Glod & Paul Haidet

  2. Harrell Health Sciences Library, Penn State College of Medicine, Hershey, PA, USA

    Nancy Adams

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  1. Nicholas Duca
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  2. Nancy Adams
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  3. Susan Glod
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  4. Paul Haidet
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All authors equally contributed to the content of the manuscript.

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Correspondence to Nicholas Duca.

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This study was approved by the Penn State College of Medicine Institutional Review Board.

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Duca, N., Adams, N., Glod, S. et al. Barriers to Learning Clinical Reasoning: a Qualitative Study of Medicine Clerkship Students. Med.Sci.Educ. 30, 1495–1502 (2020). https://doi.org/10.1007/s40670-020-01069-x

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