Teaching clinical reasoning to second-year medical students

In most U.S. medical schools, students begin clinical clerkships during their third year. They are expected to arrive prepared with the skills necessary to participate in patient-care activities, including data gathering, care coordination, and diagnostic reasoning. However, most students' training may inadequately prepare them to be proficient in diagnostic reasoning, and little time is available in the third year to develop these skills. Because of this inadequate preparation, students may become frustrated with many aspects of their clerkships. This paper describes a series of exercises developed by the author and implemented in this three years as a clinical tutor for second-year medical students in an introduction to clinical medicine course. The exercises are designed to accelerate the student's understanding of diagnostic reasoning, thereby better preparing them for the requirements of the third-year clerkship. The author describes how he uses this teaching approach and discusses in detail the method's central components. He notes that the six students he has worked with from 1993 to the present have responded very positively, and that further research is needed to explore possible long-term benefits of this teaching method.