My response

For my inquiry re-search I posed the question, “Does an inquiry learning approach lead to improvements in student clinical reasoning skills?”  I started with this question because I wondered why so many health professional education programs employ inquiry approaches such as problem based learning (PBL) and case based learning (CBL) whilst some programs (such as the program I currently work for) don’t.  Before I suggested this approach to my colleagues, I thought I should scan the literature and gather evidence that it actually does improve clinical reasoning skills.

After an extensive literature search, I concluded that PBL and CBL are the most popular forms of inquiry learning used in health professional education to develop clinical reasoning skills.  I found very little evidence of any other forms of inquiry learning being used in this context.  I also discovered that defining PBL and CBL was contentious and these terms have many different meanings depending on the curriculum design employed or the health profession it was being used to teach (O’Brien, 2015, p.290).  For this reason, there is conflicting evidence as to whether these approaches do or don’t lead to improvements in students’ clinical reasoning skills (O’Brien, 2015, p.293).

O’Brien (2015) found that there is limited evidence supporting PBL for improving clinical reasoning skills in nursing and allied health education.  However, Koh, Khoo, Wong and Koh (2008) in a systematic review of the effects of PBL on physician competency after graduation, found that a PBL approach used during medical school has positive effects on physician competency, including in the area of clinical reasoning.  Therefore, it seems that the effectiveness of this approach in developing clinical reasoning skills might be dependent upon which health profession is using this as a teaching method, with medical programs reporting more success with this approach than other health disciplines.

One of the reasons given as to why PBL may not improve clinical reasoning skills is that some researchers have found that students don’t develop a sufficient knowledge base when learning using this method (Goss, Reid, Dodds, & McColl, 2011).  However, others have found that if PBL is used in conjunction with other pedagogical approaches and supports are put in place to assist students to transition to self-directed learning, then the issue of not developing a sufficient knowledge base can be mitigated (Forsberg, Ziegert, Hult & Fors, 2016, Hoad-Reddick & Theaker, 2003, Hung & Lin, 2015, Thomas, Duddu & Gater, 2016).  Likewise, there is evidence that a CBL approach also requires adequate support and preparation if it is to be a success, and works best if used in conjunction with other pedagogical approaches (Thistlethwaite, Davies, Ekeocha, Kidd, MacDougall, Matthews, Purkis & Clay, 2012, Zijdenbos, de Haan, Valk & ten Cate, 2010).  These approaches could also be the inspiration for new types of inquiry learning (Virginia Commonwealth University, 2014). Another interesting perspective was provided by Findyartini, Hawthorne, McColl and Chiavaroli (2016) who found that western pedagogical approaches such as PBL don’t automatically improve clinical reasoning skills in other cultural contexts where cultural differences regarding attitudes to authority and uncertainty avoidance exist.

Therefore, I have concluded that inquiry learning approaches such as PBL and CBL can be used to improve student clinical reasoning skills in health professional education.  However, the evidence shows that in order for these approaches to be successful, careful curriculum planning and design need to occur, appropriate supports for this approach need to be put in place, and cultural contexts need to be taken into account.  Academic staff also need to be clear about how they will define PBL and CBL in their particular setting as these approaches can be manifested in a number of different ways.  But if used in conjunction with other types of learning activities to implement a carefully planned curriculum, inquiry learning approaches have been shown to develop many of the skills that future graduates will require, including sophisticated clinical reasoning skills.

 

References

Findyartini, A., Hawthorne, L., McColl, G., & Chiavaroli, N. (2016). How clinical reasoning is taught and learned: Cultural perspectives from the University of Melbourne and Universitas Indonesia. BMC Medical Education16(1). doi:10.1186/s12909-016-0709-y

Forsberg, E., Ziegert, K., Hult, H., & Fors, U. (2016). Assessing progression of clinical reasoning through virtual patients: An exploratory study. Nurse Education in Practice,16(1), 97-103. doi:10.1016/j.nepr.2015.09.006

Goss, B., Reid, K., Dodds, A., & McColl, G. (2011). Comparison of medical students’ diagnostic reasoning skills in a traditional and a problem based learning curriculum. International Journal of Medical Education2, 87-93. doi:10.5116/ijme.4e64.055a

Hoad-Reddick, G., & Theaker, E. (2003). Providing support for problem-based learning in dentistry: the Manchester experience. European Journal of Dental Education7(1), 3-12. doi:10.1034/j.1600-0579.2003.00246.x

Hung, C., & Lin, C. (2015). Using concept mapping to evaluate knowledge structure in problem-based learning. BMC Medical Education15(1). doi:10.1186/s12909-015-0496-x

Koh, G. C., Khoo, H. E., Wong, M. L., & Koh, D. (2008). The effects of problem-based learning during medical school on physician competency: a systematic review. Canadian Medical Association Journal178(1), 34-41. doi:10.1503/cmaj.070565

O’Brien, L. (2015). Problem-based learning. In T. Brown & B. Williams (Eds.), Evidence-based education in the health professions: Promoting best practice in the learning and teaching of students (pp. 288-300). London, United Kingdom: Radcliffe Publishing.

Thistlethwaite, J. E., Davies, D., Ekeocha, S., Kidd, J. M., MacDougall, C., Matthews, P., Clay, D. (2012). The effectiveness of case-based learning in health professional education. A BEME systematic review: BEME Guide No. 23. Medical Teacher34(6), e421-e444. doi:10.3109/0142159x.2012.680939

Thomas, G., Duddu, V., & Gater, R. (2016). Blending an e-learning package into a problem-based learning module. International Journal of Medical Education7, 279-280. doi:10.5116/ijme.5787.617d

Virginia Commonwealth University. (2014, May 5). Process oriented guided inquiry learning, Dr Isaac “Ike” Wood [Video file]. Retrieved from https://www.youtube.com/watch?v=xsrgqel5h44

Zijdenbos, I. L., De Haan, M. C., Valk, G. D., & Ten Cate, O. T. (2010). A student-led course in clinical reasoning in the core curriculum. International Journal of Medical Education1, 42-46. doi:10.5116/ijme.4c18.94a5

 

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