gms | German Medical Science

Introduction: Clinical reasoning competencies (CR) and their facilitation have been investigated for more than 35 years [1]. CR incorporates the ability to reason scientifically. In this pilot study, we used a novel framework of scientific reasoning and argumentation (SRA, conceptualised by eight epistemic activities) to investigate SRA skills of medical students in the context of clinical case discussions (CCDs), a peer teaching format designed to foster epistemic activities such as evidence evaluation or hypothesis generation [2].

Objectives: Our pilot study aimed to analyse how and in which epistemic activities students engage during clinical case discussions.

Method: 15 students discussed three clinical cases in three CCD sessions. The CCD format follows an admission-, discussion- and summary-sequence and assigns different roles to the participants: A discussant presents the facts, a peer moderates the discussion while a resident supervises it. CCDs were recorded and transcribed before we applied a coding scheme for the analysis of epistemic activities in SRA (interrater reliability: κ=0.781) adapted from the domain of social work [3].

Results: Transcripts were segmented into 3346 coding units with a distribution of 50% on admission, 41% on discussion and 9% on summary. Overall, participants predominantly engaged in Evidence Generation (EG, 34%), Communicating and Scrutinising (CS, 26.2%), Questioning (Q, 22.4%) and Evidence Evaluation (EE, 12.4%). Hypothesis Generation (HG), Drawing Conclusions (DC) and Problem Identification (PI) summed up to 2.5%, 1.1%, 0.8%, respectively. Out of all epistemic activities, 30.1% were supported by Construction and Redesign of Artefacts (CA). Finally, we found the moderator-role to be a driver of EG, CS and Q in the CCDs, whereas students engaged mostly in EE, HG, DC and PI.

Conclusion: The SRA framework by Fischer et al. provided a useful analytical basis to investigate CR in medical education [2]. The successful application of a SRA coding scheme (developed primarily for analysing reasoning processes in a different domain) in medical education supports the notion of a cross-domain validity of epistemic activities. Further research will clarify the complex interactions between epistemic activities and the roles of the participants in the CCD format.