Effect of reflective skills on family medicine resident's clinical reasoning ability
Date of Award
Master of Health Professions Education (MPHE)
Clinical reasoning is a required skill for competent patient care. Both analytical and nonanalytical processes are involved in clinical reasoning. Reflective practice improves clinical reasoning through internal analysis of practice with correction of biases leading to improvement of clinical practice. This study was undertaken with the aim of improving clinical reasoning skills of Family Medicine residents through the introduction of reflective practice at Aga Khan University. Method: This was a case study using pre-post method. A questionnaire was administrated to assess baseline level of reflection in residents, followed by a focus group discussion to determine the strategies used by residents for clinical reasoning. A workshop on reflective practice was conducted to orient about the process and levels of reflection. Residents were asked to document reflective logs on a blog, feedback was provided. Post-intervention data was collected by re-administration of the questionnaire and focus group. Pre-post focus group data was analysed and themes were extracted. Reflective blogs were analysed for level of reflection and change in practice, discussions were grouped under emergent themes. Pre-post questionnaire data was analysed for comparisons using Wilcoxin Sign Rank test on SPSS version 19.Results: Residents level of reflection increased positively after intervention with the largest increase in 'Reflection' and 'Critical Reflection' domain (4.1-4.8 and 3.8-4.5). Residents reported an improvement in clinical reasoning through development of general rules and holistic patient centred approach, use of the bio-psycho-social model of illness, understanding own limits and better communication skills. They also reported personal and professional growth. Conclusion: Reflective practice is an effective strategy to improve critical thinking and clinical reasoning skills.
Andrades, M. (2014). Effect of reflective skills on family medicine resident's clinical reasoning ability (Unpublished doctoral thesis). Aga Khan University, Karachi, Pakistan.