Perceived opportunities of clinical reasoning learning in postgraduate psychiatry training: Trainees’ and faculty’s perspectives

TL;DR

This study explores how trainees and faculty in psychiatry differ in their views on learning clinical reasoning in real-world settings.

Contribution

It identifies specific learning environments where trainees and faculty differ in perceived effectiveness for clinical reasoning skills.

Findings

Trainees and faculty differ in perceived learning effectiveness of clinical reasoning skills in structured versus clinical environments.

Advanced clinical reasoning skills are perceived as less well-learned compared to basic skills.

Peer-led tutorials and journal clubs show significant differences in perceived learning outcomes between trainees and faculty.

Abstract

Background: Learning clinical reasoning is less effective in isolation of clinical environments because contextual factors are a significant component in the clinical reasoning process. This study investigated the differences in opinions between novice and expert clinicians on learning clinical reasoning in the workplace.

Materials and Methods: The author used a cross-sectional online survey design to investigate the perceived learning of six clinical reasoning skills in 13 learning opportunities. Questionnaires were emailed to 41 postgraduate psychiatry trainee doctors and 37 faculty members. Data were analyzed descriptively. The Chi-square test was used to compare the responses of the two groups. Statistical significance was set at P < 0.05.

Results: The combined response rate was 73.07%. The two groups perceived the learning of advanced clinical reasoning skills to be lower than that of basic skills. There were significant differences in the perceived learning of basic clinical reasoning skills in self-study/exam preparations (P = 0.032), general hospital grand rounds (P = 0.049), and clinical rounds (P = 0.024 for consultant-led rounds and P = 0.038 for senior peer-led rounds). There were also significant differences in the perceived learning of advanced clinical reasoning skills among peer-led tutorials (P = 0.04), journal clubs (P = 0.006), morning reports (P = 0.002), and on-call duties (P = 0.031).

Conclusions: The trainees showed a significant preference for structured learning environments rather than clinical environments, especially for advanced clinical reasoning skills. Trainees likely struggled with cognitive overload in clinical environments. Local postgraduate psychiatry programs will likely benefit from implementing multiple educational interventions that facilitate teaching and learning clinical reasoning in complex clinical environments.

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