Original Research

What are they thinking? Facilitating clinical reasoning through longitudinal patient exposure in rural practice


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David Campbell1
FACRRM, Associate Professor, Director *

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Lucie Walters2
FACRRM, Professor Postgraduate Medical Education

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Ian Couper3
MFamMed FCFP(SA), Director and Professor of Rural Health

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Jane Greacen4
FACRRM, Senior Lecturer


1, 4 Monash University, PO Box 1497, Bairnsdale, Victoria 3875, Australia

2 Flinders University, PO Box 3570, Mount Gambier, South Australia 5290, Australia

3 Ukwanda Centre for Rural Health, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 241, Cape Town, 8000, South Africa

ACCEPTED: 16 May 2017

early abstract:

Background: This paper reports the findings from an international research workshop, held over 2 days in October, 2014 in Bairnsdale, Australia, which brought together 19 clinician teachers and medical educators who work in rural primary care.
Delegates were asked to prepare a 55-word vignette related to their experience of teaching clinical reasoning, and these case studies formed the basis of identification of key issues, further refined via a modified Delphi process.
Objectives: The objectives of the workshop were to clarify and identify the key aspects of the development of clinical reasoning in students and junior doctors, particularly as a result of longitudinal immersion in rural community practice.
Discussion: The workshop identified four key themes: the patient's story, the learners' reasoning, the context of learning, and the role of the supervisor.
Exposure to undifferentiated patient presentations is increasingly common in medical education, particularly in longitudinal integrated placements. This research explored clinicians perspectives of how students develop their clinical reasoning: by learning from patients, from their supervisors and by understanding the context of their clinical interactions.