Table 2_A combined approach of simulation-based “debriefing with good judgment” and case-based learning to enhance clinical thinking in Chinese residents.docx

ObjectiveClinical reasoning is a fundamental and critical competency for physicians. However, how to effectively help resident trainees to develop and enhance this ability remains a challenge for medical instructors. In this study, a teaching approach that combines simulation-based “Debriefing with Good Judgment” (DwGJ) with Case-Based Learning (CBL) was employed to improve the clinical reasoning among standardized training residents. The effectiveness of teaching strategy was evaluated.
MethodsThis study was designed and conducted as a randomized controlled educational trial. A total of 70 residents at the Clinical Skills Training Center of the First Affiliated Hospital of Jinan University, Guangzhou, China, were recruited in the 2023–2024 academic year. These residents from Internal Medicine, Surgery, Obstetrics and Gynecology, Pediatrics, Emergency Medicine, and Intensive Care Medicine, were randomly assigned to either a control group or a DwGJ group. There were 35 participants in each group. The control group received conventional CBL instruction, practicing skills within a clinical scenario, while the DwGJ group incorporated a DwGJ session following hands-on practice session. Upon course completion, participants evaluated the instructor and course, their clinical reasoning competencies (including clinical thinking, and systematic thinking, and evidence-based thinking) were surveyed, and theoretical and practical examination scores were compared.
ResultsThere was no significant difference between two groups in instructor evaluation. However, the DwGJ group reported significantly higher satisfaction with the course. Moreover, the DwGJ group outperformed the control group in all subcomponents of clinical reasoning, including critical thinking, systematic thinking, and evidence-based thinking. Both the theoretical test scores and skill scores were significantly higher in the DwGJ group (64.40 ± 13.22 and 80.54 ± 7.4, respectively) compared to the control group (52.34 ± 18.42, p = 0.02 and 72.32 ± 7.6, p < 0.01, respectively).
ConclusionThe integration of simulation-based DwGJ with CBL demonstrates more efficacy in enhancing resident trainees’ clinical reasoning abilities, through fostering their critical, systematic, and evidence-based thinking.