Razi Journal of Medical Sciences

Background: Clinical reasoning is important in any educational setting and should be included in all aspects of knowledge and skills of a student. In the clinical reasoning process the physician gains information by questioning the patient, compares this information with clinical findings and finally using his/her experience, reaches a diagnosis. Medical students at different levels show low reasoning and face many misdiagnoses. This study compared the clinical reasoning of the interns and residents in different clinical settings.

Methods: This study was a cross-sectional and data gathering tool was diagnostic thinking questionnaire, which had 41 questions with 6 rating scale, developed originally by Bordage and colleagues in France. Interns and residents were randomly selected from four main sections in each hospital and asked to complete the questionnaire. A total sample size of 105 residents and 100 interns were studied in these hospitals. Collected data were entered into SPSS 16 statistical software and analyzed using descriptive statistics.

Results: 205 residents and interns completed the questionnaire (response rate of %73). The findings showed that the total DTI score of interns and residents (158.13, 161.66) had no significant differences (p=0.056). Interns, in structure of memory scored 82.87 while residents scored 85.04, respectively and differences (p= 0.076) were not significant. Interns and residents scored respectively, 75.26 and 76.62 in flexibility in thinking and the difference (p= 0.108) was not significant.

Conclusion: By comparing studies and research we find that interns and residents are poor in clinical reasoning. Teaching clinical reasoning requires knowledge, but knowledge alone is not enough. Rather more important than knowledge is the science of clinical practice and patient experience. Another issue that must be noted is that education of clinical reasoning must be problem-based and student-centered and the most suitable learning environment is problem-oriented education conducted in small groups.