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Remediating clinical reasoning: integrating algorithm, process, and milestones 

09-22-2021 11:40

Remediation in residency training is common enough to require significant attention, and uncommon enough that standardization of the process can be difficult to achieve (Chou et al., 2019). This is especially true for learners who struggle with clinical reasoning (Kalet et al., 2017). Whether related to specific learning problems or gaps in medical training, remediation of clinical decision making in residency is a high stakes endeavor for learners, patients, and residency programs alike. Diverse teaching styles among faculty can compound the challenge of achieving consistent competency-based feedback that can both serve to teach effectively and provide clear boundaries for promotion or dismissal. Algorithms for the improvement of clinical reasoning have shown promise in medical education (Guerrasio & Aagaard, 2014), but can be difficult to implement during residency because of the inflexibility of schedules and the high stakes. As such, early identification and consistent, focused feedback related to clinical reasoning are imperative to the success of learners in residency, central for evidence-based patient care, and integral to the sustainability of individual residency programs. During this workshop, participants will review best practices for early identification of residents who struggle with clinical reasoning. We will discuss Guerrasio and Aagard’s (2014) model for addressing clinical reasoning, review strategies for implementation during inpatient and outpatient settings, and discuss milestone linked criteria to enhance consistency of judgments about competence.



Participants in this session will…

  • Identify important strategies for early identification of learners who need help with clinical reasoning
  • Analyze key elements of clinical reasoning to apply to remediation programs
  • Combine specific criteria with ACGME Family Medicine Milestones(ACGME, 2019) to improve clarity of feedback and decision making.

Author(s):Christopher Haymaker
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