Clinical reasoning for acute dyspnoea: comparison between final-year medical students from discipline- and competency-based undergraduate programmes

Abstract

Abstract: Clinical reasoning for acute dyspnoea: Comparison of final-year medical students from discipline- andcompetency-based undergraduate programmes.

Background: The global shift to competency-based medical education aims to improve the performance of itstrainees, including in the key competency domain of clinical reasoning. However, research on whether such educationactually improves clinical reasoning is sparse. The purpose of this study is to compare assessed clinical reasoningperformance in digitally presented cases of acute dyspnoea between final-year medical students from a traditional,discipline-based and those from an integrated, competency-based undergraduate programme.

Methods: A total of 60 medical students in their final-year clerkships participated in the study; 30 were from adiscipline-based programme, and 30 were from a competency-based programme of the same faculty. The studentscompleted a knowledge test consisting of 22 single choice items and a computer-based test of clinical reasoning withsix video-based case scenarios with different underlying diseases leading to dyspnoea. The operationalized measures ofclinical reasoning were the number and relevance of the diagnostic tests chosen, time to diagnosis and diagnosticaccuracy.

Results: The two groups did not differ in their knowledge of the acute dyspnoea content domain. With regard toclinical reasoning, the selection of relevant tests, time required to make a diagnosis and accuracy of the diagnosisvaried across the six case scenarios in both groups. However, the results from the measures of the clinical reasoningprocess did not differ between the students from the two types of undergraduate medical programmes. No significantdifferences were found with regard to the selection of relevant diagnostic tests (M = 63.8% vs. M = 62.8%), the time toa diagnosis (M = 128.7 s vs. M = 136.4 s) or the accuracy of diagnosis (M = 82.2% vs. M = 77.0%).

Conclusions: Key indicators of the clinical reasoning process, when assessed with objectively measured parameters,did not differ between final-year medical students from a traditional, discipline-based and those from an integrated,competency-based undergraduate programme in the domain of acute dyspnoea. The results substantiate and expandthose of previous studies based on subjective assessor ratings that showed limited change in the clinical reasoningperformance of medical students with competency-based undergraduate education.