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The student is key: a realist review of educational interventions to develop analytical and non-analytical clinical reasoning ability

Richmond, Anna; Cooper, Nicola; Gay, Simon; Atiomo, William; Patel, Rakesh

The student is key: a realist review of educational interventions to develop analytical and non-analytical clinical reasoning ability Thumbnail


Authors

Anna Richmond

Nicola Cooper

Simon Gay

William Atiomo

Rakesh Patel



Abstract

Background
Clinical reasoning refers to the cognitive processes used by individuals as they formulate a diagnosis or treatment plan. Clinical reasoning is dependent on formal and experiential knowledge. Developing the ability to acquire and recall knowledge effectively for both analytical and non‐analytical cognitive processing has patient safety implications. This realist review examines the way educational interventions develop analytical and non‐analytical reasoning ability in undergraduate education. A realist review is theory‐driven, seeking not only to identify if an intervention works, but also understand the reasons why, for whom, and in what circumstances.

Aim
To develop understanding about the way educational interventions develop effective analytical and non‐analytical clinical reasoning ability, when they do, for whom and in what circumstances.

Methods
Literature from a scoping search, combined with expert opinion and researcher experience was synthesised to generate an initial programme theory (IPT). Four databases were searched and articles relevant to the developing theory were selected as appropriate. Factors affecting educational outcomes at the individual student, teacher and wider organisational levels were investigated in order to further refine the IPT.

Results
28 papers contributed to the overall programme theory. The review predominantly identified evidence of mechanisms for interventions at the individual student level. Key student level factors influencing the effectiveness of interventions included an individual’s self‐confidence, self‐efficacy and pre‐existing level of knowledge. These contexts influenced a variety of educational interventions, impacting both positively and negatively on educational outcomes.

Discussion
Development of analytical and non‐analytical clinical reasoning ability requires activities that enhance knowledge acquisition and recall alongside the accumulation of clinical experience and opportunities to practise reasoning in real or simulated clinical environments. However, factors such as pre‐existing knowledge and self‐confidence influence their effectiveness, especially among individuals with ‘low knowledge’. Promoting non‐analytical reasoning once novices acquire more clinical knowledge is important for the development of clinical reasoning in undergraduate education.

Citation

Richmond, A., Cooper, N., Gay, S., Atiomo, W., & Patel, R. (2020). The student is key: a realist review of educational interventions to develop analytical and non-analytical clinical reasoning ability. Medical Education, 54(8), 709-719. https://doi.org/10.1111/medu.14137

Journal Article Type Article
Acceptance Date Feb 6, 2020
Online Publication Date Feb 21, 2020
Publication Date 2020-08
Deposit Date Feb 21, 2020
Publicly Available Date Mar 29, 2024
Journal Medical Education
Print ISSN 0308-0110
Electronic ISSN 1365-2923
Publisher Wiley
Peer Reviewed Peer Reviewed
Volume 54
Issue 8
Pages 709-719
DOI https://doi.org/10.1111/medu.14137
Public URL https://nottingham-repository.worktribe.com/output/4006984
Publisher URL https://onlinelibrary.wiley.com/doi/abs/10.1111/medu.14137
Additional Information This is the peer reviewed version of the following article: Richmond, A., Cooper, N., Gay, S., Atiomo, W. and Patel, R. (2020), The student is key: a realist review of educational interventions to develop analytical and non?analytical clinical reasoning ability. Med Educ. , which has been published in final form at ttps://doi.org/10.1111/medu.14137. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.

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