Exploring clinical reasoning using team-based learning (TBL) (Lincoln)

Code

MEDS3083

School

Medical Education Centre

Level

3

Credits

10

Semesters

Autumn UK

Summary

This module will encourage the development of students’ skills in clinical reasoning, which has been defined as “the thinking and decision-making processes associated with clinical practice” (Cooper and Frain, 2017) and is a multi-faceted key skill of the competent medical practitioner. 
 
Students will work through 5 clinical cases, each of which will exemplify particular aspects of clinical reasoning and/or problems that can arise in the clinical reasoning process.  The module will be delivered using team-based learning (TBL), a unique educational approach involving a specific sequence of individual work, team work and problem-solving, first developed by Larry Michaelsen in 1979 (Sibley and Ostafichuk, 2014).  Each TBL session will take approximately 3 hours and 4 of the sessions will generate marks that count towards the students’ summative assessment results.  Marks will be generated from the ‘individual readiness assurance tests’ (iRATs) and ‘team readiness assurance tests’ (tRATs) that students undertake during the sessions.  Preparation for the iRATs and tRATs will be undertaken by students before each TBL session. 
 
Students will also be expected to provide feedback to their peers on their performance on the team tasks, and to critically analyse and reflect on their own performance, based on feedback that they themselves have received from members of their team.  This element of the learning from the module will be assessed via a reflective account of their response to feedback, which each student will have to submit by the end of the module. 
 
References 
Cooper, N. and Frain, J. (2017) Clinical reasoning: an overview. In: N. Cooper and J. Frain (eds.) ABC of clinical reasoning. Chichester, UK: BMJ Books, 1. 
Sibley, J. and Ostafichuk, P. (2014) Introduction to team-based learning. In: J. Sibley and P. Ostafichuk (eds.) Getting started with team-based learning. Sterling, USA: Stylus Publishing, 7-8.  

Target Students

Third year medical students on the A10L programme

Classes

• One 3-hour workshop each week for 5 weeks

Team-based learning activity (which includes in-class assessment), running approximately once every two weeks during the Semester.

Assessment

• 60% Inclass Exam (written): Combined marks from readiness assurance tests undertaken in TBL sessions 2-5 (iRAT:tRAT in 2:1 ratio). Each iRAT/tRAT combination will provide 25% of the marks for this component of assessment. Due to the team-based element of this assessment, it is not suitable for use with only a small number of students so reassessment will be by coursework only. These elements will take place over approximately a four week period.
• 40% Coursework: A 1,500 word reflective account of the student's response to at least 1 item of peer feedback collected after TBL session 2 or 3.

Assessed by end of autumn semester

Educational Aims

Learning Outcomes

The students will achieve learning outcomes within the GMC’s Outcomes for Graduates (2018) as follows: 

(for “Newly qualified doctors” read “Students”)  

Professional and ethical responsibilities 

2.  Newly qualified doctors must behave according to ethical and professional principles. They must be able to: 

p. explain and demonstrate the importance of professional development and lifelong learning and demonstrate commitment to this 

t. explain and demonstrate the importance of engagement with revalidation, including maintaining a professional development portfolio which includes evidence of reflection, achievements, learning needs and feedback from patients and colleagues 

Leadership and team working 

8.  Newly qualified doctors must recognise the role of doctors in contributing to the management and leadership of the health service.  They must be able to: 

a. describe the principles of how to build teams and maintain effective team work and interpersonal relationships with a clear shared purpose 

b. undertake various team roles including, where appropriate, demonstrating leadership and the ability to accept and support leadership by others 

c. identify the impact of their behaviour on others 

Communication and interpersonal skills 

10.  Newly qualified doctors must be able to communicate effectively, openly and honestly with patients, their relatives, carers or other advocates, and with colleagues, applying patient confidentiality appropriately. They must be able to: 

a. communicate clearly, sensitively and effectively with patients, their relatives, carers or other advocates, and colleagues from medical and other professions, by: 

- listening, sharing and responding 

- demonstrating empathy and compassion demonstrating effective verbal and non-verbal interpersonal skills  

Diagnosis and medical management 

14.  Newly qualified doctors must be able to work collaboratively with patients, their relatives, carers or other advocates to make clinical judgements and decisions based on a holistic assessment of the patient and their needs, priorities and concerns, and appreciating the importance of the links between pathophysiological, psychological, spiritual, religious, social and cultural factors for each individual. They must be able to: 

a. propose an assessment of a patient’s clinical presentation, integrating biological, psychological and social factors, agree this with colleagues and use it to direct and prioritise investigations and care  

c. interpret findings from history, physical and mental state examinations 

d. propose a holistic clinical summary, including a prioritised differential diagnosis/diagnoses and problem list 

f. interpret the results of investigations and diagnostic procedures, in collaboration with colleagues if necessary 

g. synthesise findings from the history, physical and mental state examinations and investigations, in collaboration with colleagues if necessary, and make proposals about underlying causes or pathology 

h. understand the processes by which doctors make and test a differential diagnosis and be prepared to explain their clinical reasoning to others 

i. make clinical judgements and decisions with a patient, based on the available evidence, in collaboration with colleagues and as appropriate for their level of training and experience, and understand that this may include situations of uncertainty 

Applying biomedical scientific principles 

22.  Newly qualified doctors must be able to apply biomedical scientific principles, methods and knowledge to medical practice and integrate these into patient care. This must include principles and knowledge relating to anatomy, biochemistry, cell biology, genetics, genomics and personalised medicine, immunology, microbiology, molecular biology, nutrition, pathology, pharmacology and clinical pharmacology, and physiology. They must be able to: 

b. explain the relevant scientific processes underlying common and important disease processes 

c. justify, through an explanation of the underlying fundamental principles and clinical reasoning, the selection of appropriate investigations for common clinical conditions and diseases 

d. select appropriate forms of management for common diseases, and ways of preventing common diseases, and explain their modes of action and their risks from first principles 

e. describe medications and medication actions: therapeutics and pharmacokinetics; medication side effects and interactions, including for multiple treatments, long term physical and mental conditions and non-prescribed drugs; the role of pharmacogenomics and antimicrobial stewardship 

f. analyse clinical phenomena and conduct appropriate critical appraisal and analysis of clinical data, and explain clinical reasoning in action and how they formulate a differential diagnosis and management plan 

Conveners

• Professor David O'Brien