1. TDG 2008 Report Illness scripts for improving clinical reasoning Anna Lee, Tony Gin, Charles Gomersall, Warwick Ngan Kee, Gavin Joynt, Anthony Ho, Juliana Chan, Lex Vlantis, James Griffith, William Wong, Coleman Fung

2. Project objectives To develop and implement a teaching module to improve 4 th year medical students’ clinical reasoning skills To assess students’ level of clinical reasoning skills

3. Teaching intervention (Feb 2008) Rotation to 4 th year Family Medicine module Short lecture on clinical reasoning and illness script theory (0.5h) Small group work on “problem representation” using thinking aloud approach with teacher (1.5h) Individual guided computer work using clinical reasoning scenarios (1.5h)

4. Example of clinical reasoning problem Pull down menus

5. Deliverables Developed and debugged a web-based clinical reasoning scoring system using clinical scenarios from University of Queensland that were previously validated against GPs Developed workshop materials (tutors and students manuals) Conducted workshop in Feb 2008 Assessed effectiveness of workshop at end of CFM rotation in April 2008

6. Assessing students’ learning outcome StudentsBegin rotationTeaching packageEnd of rotation InterventionDiagnostic Thinking Inventory (25 min online) Clinical reasoningDiagnostic Thinking Inventory + clinical reasoning scenarios on web (2 hours) ControlDiagnostic Thinking Inventory (25 min online) Self-directed learning Diagnostic Thinking Inventory + clinical reasoning scenarios on web (2 hours)

7. Diagnostic Thinking Inventory P=0.64

8. Clinical reasoning problem score P<0.001

9. Student feedback with Workshop StatementMedian (IQR)* The “thinking aloud” approach was helpful for improving my clinical reasoning skill 5(5-5) Completing the web-based clinical scenarios helped improved my clinical reasoning 5(5-6) Overall, I am satisfied with the course5(5-6) *1=strongly disagree to 6=strongly agree

10. Conclusions Certain aspects of clinical reasoning improved Identification and interpretation of relevant clinical features and hypothesis generation improved BUT inconclusive about improving flexibility of thinking and organization of knowledge