A medical perspective on the adventures of Sherlock Holmes

Enhancing the Clinical Reasoning Skills of Postgraduate Students in Internal Medicine Through Medical Nonfiction and Nonmedical Fiction Extracurricular Books

OBJECTIVE

To improve the clinical reasoning skills of postgraduate students in internal medicine through 2 kinds of extracurricular books: medical nonfiction and nonmedical fiction.

METHODS

Clinical reasoning is difficult to define, understand, observe, teach, and measure. This is an educational innovation under an experimental framework based on a cognitive intervention grounded in constructivist and cognitivist theories. This study was conducted from June 1, 2014, through May 31, 2015. It was a pre-post, randomized, controlled, prospective, mixed-methods, small-group study. The intervention was through medical nonfiction and nonmedical fiction books. The process was structured to ensure that the students would read the material in phases and reflect on them. Clinical reasoning (pretests and posttests) was quantitatively assessed using the Diagnostic Thinking Inventory (DTI) and clinical reasoning exercises (CREs) and their assessment using a rubric. A qualitative design was used, and face-to-face semistructured interviews were conducted.

RESULTS

Posttest total scores (DTI=188.92; CREs=53.92) were higher for the study group after the intervention compared with its own pretest scores (DTI=165.25; CREs=41.17) and with the pretest (DTI=159.27; CRE=40.73) and posttest (DTI=166.91; CREs=41.18) scores of the control group. Interviews with the study group confirmed that the intervention was acceptable and useful in daily practice.

CONCLUSION

We introduced, evaluated, and proved an approach to teaching-learning clinical reasoning based on the assumption that the clinical reasoning skills of postgraduate students in internal medicine can be enhanced through 2 kinds of extracurricular books and that fun as well as interest will enhance learning. This study is not only about teaching-learning clinical reasoning but also about the humanities in medical education.

Revalidating Sherlock Holmes for a role in medical education

Sir Arthur Conan Doyle endowed Sherlock Holmes with extraordinary skills that Dr Watson and others found incomprehensible until Holmes gave explanations, often in the form of memorable maxims and short monologues. Intentionally or not, Doyle left us crime-solving precepts that still inform aspects of medical practice. Experienced clinicians share with Holmes the dilemma of how to make complex, often unconscious, capability accessible to novices. Doctors still invoke Holmes's methods in clinical contexts, but the validity of some of the parallels has been challenged and quoting the more popular sayings has been equated with conceit. This paper examines how the use of selected maxims and monologues can help to link abstract principles and live context in a credible way in order to make aspects of clinical reasoning and professional behaviour more accessible and memorable.