Introduction

Clinical reasoning strategies (CR) employ hypothetical-deductive and inductive models as their theoretical basis. The first is based on the generation of hypotheses derived from a knowledge of pathologies and the second on a generalization derived from data on the case or an identification of a pattern. Doctors’ or students’ thoughts may be evaluated by the “think aloud” technique (TAT).

Objectives

To identify the CR strategies used by medical students at the end of the basic cycle, as well as the organization and contents of their knowledge, analyzing an internal medicine prototype clinical case by means of the TAT.

Method

A qualitative study was conducted on undergraduate medical students at the end of the basic cycle in a Brazilian university in 2014. The theory of prototypes served as the basis for building the clinical case, based on 41 students’ perceptions of signs, symptoms, syndromes, and diseases typical of internal medicine. The TAT was individually applied to 30 randomly selected students in the original sample, in order to obtain an audio record of the verbalization of their reasoning processes in light of the case presented. A transcript of the speeches allowed us to evaluate the texts by means of content analysis, and to categorize the reasoning techniques employed. Semantic axes were also identified and subsequently categorized into six classes: symptoms, signs, syndromes, diseases, factual data, and processes.

Results

A total of 105 diagnostic hypotheses were created, in which 12 different types were identified as primary and 12 as secondary, with a mean of 3.5 principal hypotheses per student. The most commonly used reasoning style for developing the PDH was scheme-inductive (SI) = 42.3%, followed by pattern recognition (PR) = 21.2%, mixed SI (15.4%), mixed PR (10.6%), and hypothetic-deductive (10.6%). As for knowledge organization and content, a mean of 12.9 semantic axes was recorded per student, with 20.9 interpretation processes per student and 6.8 combination processes per student.

Conclusions

The inductive reasoning strategy is the most commonly used for developing PDHs among medical students at the end of the basic cycle. Students revealed a solid semantic network and skills in interpretation processes; however their combined abilities were limited when compared to those of experienced doctors.

        · resumo em Português     · texto em Português     · Português ( pdf )