Principles and Practice of Case-based Clinical Reasoning Education: A Method for Preclinical Students

This volume describes and explains the educational method of Case-Based Clinical Reasoning (CBCR) used successfully in medical schools to prepare students to think like doctors before they enter the clinical arena and become engaged in patient care. Although this approach poses the paradoxical problem of a lack of clinical experience that is so essential for building proficiency in clinical reasoning, CBCR is built on the premise that solving clinical problems involves the ability to reason about disease processes. This requires knowledge of anatomy and the working and pathology of organ systems, as well as the ability to regard patient problems as patterns and compare them with instances of illness scripts of patients the clinician has seen in the past and stored in memory. CBCR stimulates the development of early, rudimentary illness scripts through elaboration and systematic discussion of the courses of action from the initial presentation of the patient to the final steps of clinical management. The book combines general backgrounds of clinical reasoning education and assessment with a detailed elaboration of the CBCR method for application in any medical curriculum, either as a mandatory or as an elective course. It consists of three parts: a general introduction to clinical reasoning education, application of the CBCR method, and cases that can used by educators to try out this method

A Recognition Study Testing the Psychological Validity and Development of Illness Scripts

Purpose: This study investigates whether the recognition memory phenomena previously found for script-based stories also apply to illness scripts, the hypothesized mental structures expert physicians apply in medical diagnosis. In addition, the development of these scripts is investigated. Method: Second and sixth year students and experienced family physicians participated; the influence of typicality of information (prototypical versus atypical statements), textual presence (verbatim or implicit), and delay (15 min or 1 week) on recognition memory discrimination was investigated in a 3×2×2 ANOVA design and on recognition reaction times (RTs) in a 3×2×2×2 ANOVA design. Results: The expected developmental differences could not be replicated; all participants appear to dispose of illness script structures, which explains poorer memory discrimination for prototypical than atypical information. The results also show that at a longer delay, medical students and physicians are more inclined to infer unstated, but script-typical information. With regard to the RTs, the interaction between typicality and textual presence on RTs could be replicated: RTs for prototypical unstated items were longer than for any of the other types of information. Apart from this, RTs for different statements did not show a consistent pattern. Discussion: The superior memory discrimination for script atypical, compared with script prototypical, information, and at immediate retention, compared to delayed retention supports theoretical notions as well as previous research on illness scripts as general event representations with actual case information “tagged” to these stored representations. This tagged information decays over time. In terms of script development, all participants appear to have their knowledge structured in illness scripts, even students who have little experience with the diseases included in the study. Keywords: Medical expertise, Illness scripts, Diagnosis, Recognition memory, Memory discriminatio