Use of a clinical reasoning scaffolding tool improves future student clinical reasoning performance

ABSTRACT

Introduction: Clinical reasoning skills are arguably the most important skill set a healthcare professional can possess. Anecdotally, students in the latter half of pharmacotherapy course series were underachieving in developing medication-centric patient assessments and goals from collected patient data. Scaffolding is a pedagogy used to progressively advance students toward stronger understanding, skill acquisition, and independence in learning process. A clinical reasoning scaffolding tool (CRST) was designed to improve students' ability to collect pertinent information, assess patient medication therapy problems, and develop appropriate goals of therapy with specific monitoring parameters. Research Question or Hypothesis: Can a CRST improve student clinical reasoning performance? Study Design: Prospective observational cohort Methods: The CRST was implemented in Fall 2020. To assess its impact, student performance on pharmacotherapy clinical reasoning think-alouds (CRTA) in Spring 2021 were compared to historical 2020 CRTAs not exposed to CRST. Students were evaluated using entrustable professional activity-like (EPA) ratings on five CRTA sections (Findings, Assessment/Goals, Recommendations, Monitoring, Rationale) and a Percent Grade calculated. Median EPA ratings and Percent Grade were compared between 2020 and 2021 cohorts using Mann-Whitney U or Kruskal-Wallis test which were also conducted, when appropriate, to assess impact of covariates including experiential education and case progression. CRTA cases during the beginning of COVID19 were excluded from analysis. Results: Twenty-six CRTA from 2020 and 56 from 2021 were analyzed. To minimize the effect of case progression only the first two CRTAs were included. The CRST cohort had significantly higher Assessment/Goals (2[2-2.5] vs. 2[1.5-2],p=0.001) and Monitoring (2[2-2.5] vs 1.5[1.5-1.75],p<0.001) EPA-ratings, but there was no difference in Findings. Additionally, there was a significant improvement in Percent Grade in the CRST cohort (86% vs 83%, p<0.001). Conclusion: The implementation of a CRST in an early course significantly improved future student clinical reasoning performance in assessing MTPs, developing goals of therapy, and patient monitoring.