Perception of medical students on the development of the clinical reasoning competence

Abstract: Introduction: The way by which physicians process clinical reasoning is a relevant topic in the discussions on medical education because, in medical activity, the ultimate goal is to obtain the correct diagnosis and conduct. The challenge is to highlight which factors influence this performance. Objective: The objective of this study is to understand how the development of the clinical reasoning competence occurs according to the medical students’ perception. Method: This research has a descriptive focus and employs a qualitative approach in the ordering of data, classification process, and final analysis of information from 36 semi-structured interviews with medical students, from July to September 2020, in Curitiba, Paraná, Brazil. Result: Thematic analysis was carried out, and the category ‘perception of the factors that influence its achievement’ emerged, with the ‘methodological and curricular structure’ subcategories perceived as the main influencing factors, through characteristics such as interdisciplinarity, early interaction with practical activities, stimulus to autonomy and teaching guidance. Participation in monitoring, academic leagues and extension projects were also considered, as well as the experience of the process of learning appropriation. Conclusion: The present study addresses the topic of clinical reasoning and brings as a contribution the analysis of the factors that influence its development, during undergraduate school, based on the students’ viewpoint. Its results bring benefits to medical education, as they expand the understanding of the process of developing the clinical reasoning competence.

摘要：
引言 医师开展临床推理（clinical reasoning）的过程是医学教育研讨中的重要议题，因医疗活动的核心目标在于获取准确的诊断与诊疗方案。当前研究的关键挑战在于明确哪些因素会影响医师的临床推理表现。

研究目的：本研究旨在基于医学生的主观感知，探究临床推理能力的发展路径。

研究方法：本研究为描述性研究，采用质性研究范式，对2020年7月至9月在巴西巴拉那州库里提巴开展的36场医学生半结构化访谈所得数据进行整理、分类与最终分析。

研究结果：本研究采用主题分析法，提炼出“影响临床推理能力达成的感知因素”这一核心类别，其中“方法论与课程结构”被视为最主要的影响因素，具体表现为跨学科教学、早期实践活动参与、自主性激励与教学指导等特征。此外，参与临床见习、学术社团与拓展项目，以及学习内化过程的体验也被纳入影响因素范畴。

研究结论：本研究围绕临床推理主题展开，基于医学生视角分析了本科阶段影响其临床推理能力发展的各类因素，为该领域提供了新的研究参考。本研究结果有助于深化对临床推理能力培养过程的认知，对医学教育实践具有积极的借鉴价值。