Effect of chart-stimulated recall (CSR) on improving clinical reasoning and decision-making of histopathology residents

Date of Award

9-2025

Degree Type

Thesis

Degree Name

Master of Health Professions Education

First Advisor

Dr Naila Nadeem

Second Advisor

Dr Javeria Rehman

Third Advisor

Dr Sana Saeed

Department

Educational Development

Abstract

Background: Chart-stimulated recall (CSR) combines the analysis of clinical documentation, oral exams that explore cognitive processes, and detailed feedback to improve diagnostic decisions. Developing clinical reasoning is crucial for histopathologists to make accurate diagnoses. In routine sign-out sessions, residents review cases alongside faculty, providing opportunities for feedback and discussion. However, a consistent and structured feedback framework like CSR remains inadequate, which may contribute to persistent gaps in diagnostic interpretation and communication. Implementing CSR can therefore bridge this gap by promoting reflective learning and structured feedback, ultimately strengthening diagnostic competence in histopathology training.  The purpose of this study was to assess the impact of CSR on improving clinical reasoning and decision-making skills among histopathology residents at AKU.
Method: A mixed-methods embedded design was employed to collect qualitative data and provide an explanation for the quantitative results. Six residents from years 1 to 5 received five cases each in the pre-CSR phase, underwent an oral interview discussing the preliminary drafts of the histopathology reports, with a focus on the clinical reasoning and decision-making skills of the residents, followed by structured feedback as an intervention from two assessors. Later, another five cases on similar themes were discussed in the post-CSR session. To gain insight into participants' experience and perceptions, focus group discussions for residents and in-depth interviews for the faculty were recorded.
Results: The overall score of assessment (CBD sheet) improved significantly following the CSR intervention, with a mean difference of -0.76 points (95% CI: -1.01, - 0.52); t (103.62) : -6.172; p < 0.001). A Cohen's d of -1.127 indicates that l3 mean Post-cSR scores were 1.127 standard deviations higher than pre-cSR scores, reflecting a large effect size. Across individual items, all domains showed significant post-cSR improvements (p < 0.001). overall score had an rcc of 0.72 (95% cr:0.57-0.82). Both faculty and residents perceived CSR as a positive learning experience in enhancing clinical reasoning, decision making as well as an effective communication to the physicians.
Conclusion: Residents' scores on interviews improved significantly after the chart stimulated Recall discussion compared to the pre-CSR assessment supporting the hypothesis of our study, that cSR is an effective and appropriate technique for enhancing the clinical reasoning histopathology residents. and decision-making skills of Histopathology residents.

First Page

1

Last Page

77

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