Learning processes in Bedside Teaching that Foster Clinical Reasoning in Students: A Qualitative Study

Purpose: Clinical Reasoning (CR) refers to the cognitive processes required by clinicians to diagnose and manage patients' medical problems. The learning of CR skills is a complex task. Workplace based patient encounters, followed by discussions with clinicians, are a crucial part of the clinical clerkships. We explored the learning processes that take place during inpatient bedside teaching (BST) that help students develop CR skills. Methods: A naturalistic study design in the real life inpatient setting was used to explore the learning processes that facilitate CR in the patient encounter of fifth-year medical students during BST in medicine, surgery, pediatrics and obstetrics, and gynecology clerkships. Learning processes were identified using Stimulated Recall procedure. The data were analyzed using qualitative methods of constant comparative analysis, associated with the grounded theory approach. Results: We identified several themes in our analysis which represented learning processes recalled during CR instances in BST. Application of students' prior knowledge to patient care, discussion of clinical concepts in the context of the patient's case, and giving justification for responses during the discussion were the most frequent themes. The themes showed that the processes of problem representation and evaluation occur repeatedly during CR and also highlighted the contextual nature of CR. The learning processes related to CR were identified at all stages of the student-patient encounter: while doing the history and physical examination, formulating a differential diagnosis, and developing management plans for the patient. The themes were independent of disciplines. Conclusions: CR processes start very early in the student-patient interaction and continue in all subsequent stages of the encounter. The data we obtained in our study helps to describe in detail what happens in BST which relates to CR. We derived several implications which can help undertsand the learning processes related to CR in BST.