The Student-Generated Reasoning Tool (SGRT): Linking medical knowledge and clinical reasoning in preclinical education

Ivry Zagury-Orlyab* , Daniel S. Kaminc, Edward Krupatd, Bernard Charline, Nicolas Fernandezef & Krisztina Fischerga Faculty of Medicine, Université de Montréal, Montreal, Canadab Harvard Medical School, Boston, MA, USAc Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Boston, MA, USAd Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USAe Centre for Pedagogy Applied to the Health Sciences, Department of Surgery, Faculty of Medicine, Université de Montréal, Montreal, Canadaf Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université de Montréal, Montreal, Canadag Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USAIvry Zagury-Orly, BSc, MMSc, was, when this study occurred, a student in the Master’s in Medical Education Program, Harvard Medical School, Boston, Massachusetts, United States. He is currently a fourth-year medical student, Faculty of Medicine, Université de Montréal, Montreal, Quebec.Daniel S. Kamin, MD is a gastroenterologist and assistant professor of pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Boston, Massachusetts.Edward Krupat, PhD, is associate professor of medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.Bernard Charlin, MD, PhD, is professor of surgery, Centre for Pedagogy Applied to the Health Sciences, Department of Surgery, Faculty of Medicine, Université de Montréal, Montreal, Quebec.Nicolas Fernandez, PhD, is associate professor, Centre for Pedagogy Applied to the Health Sciences, Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebec.Krisztina Fischer, MD, PhD, MMSc, is assistant professor of radiology, Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts.CONTACT Ivry Zagury-Orly ivry.zagury-orly@umontreal.ca Faculty of Medicine, Université de Montréal, 2900 Edouard Montpetit Blvd, Montreal, Quebec H3T 1J4, CanadaSupplemental data for this article can be accessed here.AbstractIntroduction The simultaneous integration of knowledge acquisition and development of clinical reasoning in preclinical medical education remains a challenge. To help address this challenge, the authors developed and implemented the Student-Generated Reasoning Tool (SGRT)—a tool asking students to propose and justify pathophysiological hypotheses, generate findings, and critically appraise information.Methods In 2019, students in a first-year preclinical course (n = 171; SGRT group) were assigned to one of 20 teams. Students used the SGRT individually, then in teams, and faculty provided feedback. The control group (n = 168) consisted of students from 2018 who did not use SGRT. Outcomes included academic performance, effectiveness of collaborative environments using the SGRT, and student feedback.Results Students were five times more likely to get questions correct if they were in the SGRT group versus control group. Accuracy of pathophysiological hypotheses was significantly lower for individuals than teams. Qualitative analysis indicated students benefited from generating their own data, justifying their reasoning, and working individually as well as in teams.Conclusions This study introduces the SGRT as a potentially engaging, case-based, and collaborative learning method that may help preclinical medical students become aware of their knowledge gaps and integrate their knowledge in basic and clinical sciences in the context of clinical reasoning.