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Case-Based Clinical Reasoning

Clinical reasoning refers to inferential processes used to collect, analyze information, and make decisions concerning a patient’s problems, diagnosis and treatment. Interactive engagement among students during discussions is considered to enhance learning. Accordingly, in a collaborative context, case-based learning is particularly advantageous. The curriculum developers encounter challenges as they strive to implement competence-oriented frameworks. In this perspective, the importance of clinical reasoning skills is in making appropriate medical decisions and avoiding diagnostic errors Weidenbusch et al. (2019) researched to investigate how effective the clinical case discussions (CCD) method can be in student medical education. The research hypothesis, study participant, design, result, strengths, weaknesses, and conclusion are all essential parts of their article.

Research Objectives and Hypotheses

The study aimed to foster clinical reasoning as a backbone of medical education. The researchers proposed clinical case discussions (CCDs) approach in case-based peer teaching to encourage these skills in students. In so doing, the study compared different formats of CCD with varying social interaction degrees. From this perspective, the study hypothesized as follows:

Live CCD sessions’ participation could highly increase skills associated with clinical reasoning rather than simple interpretation.

More interactive course formats could improve clinical reasoning skills than less interactive course formats.

Study Participants

The research trial involved 90 research participants. Initially, the study involved 106 Medical Faculty of LMU Munich volunteer medical students. After a two-step randomization procedure, about 100 students were enrolled. The researchers stratified participants by creating triplets depending on variables such as gender, age, previous CCD participation, pre-test knowledge application, and year of study. They also randomly assigned the respondents to the experimental groups for every triplet. Eventually, 59 females and 31 males between 20 and 41 completed the trial.

Study Design

The study used a single-centre randomized controlled trial design that encompassed five-course sessions. The researchers introduced the participants to the CCD approach principles one week before the first CCD session. There was this trial’s sequence during the preliminary session, where the participants carried out a pre-test (T_0) knowledge application. During the experimental stage, the participants had also to attend three weekly course sessions, each 90 min in one of the three investigational clusters with corresponding CCD formats. Additionally, there was a post-test knowledge application (T_1) during the last investigational course session and a delayed (T_2) post-test two weeks following interventional course completion.


The researchers discovered that Live-CCD recorded higher learning outcomes than less interactive formats. It is consistent with the study hypothesis that clinical reasoning skills indicated the topmost improvement in the group of Live-CCD as the knowledge application test measured. The Live-CCD group recorded the best outcomes proceeded by Video-CCD groups, and then paper-class. Researchers found no variation between Video-CCD and Live-CCD groups in (T_2). However, both outpaced the group in the paper class. For the subjective learning outcomes, better ratings were significantly on the Live-CCD than in the other formats.

Strengths and Weaknesses

The study is the first that investigates clinical case discussion implementation in undergraduate medical education. It is also strong in comparing clinical case discussions with diverse social interaction grades. However, it also indicated several weaknesses. First, the nature of this study is single-centred, and its sample size is relatively small. As a result, it requires study findings validation before implementing the CCD approach on a large scale. According to the article, there were no limits on the time students worked on the cases, and thus the study cannot entirely point out that single-leaner formats and mainly the Paper-Cases group used less time. Additionally, the study’s used knowledge test application hindered in-depth reasoning skills analysis.


The study proved the CCD approach as a sustainable ad effective resource in clinical reasoning teaching. The authors conclude that outcomes from subjective learning highlight the significance of students’ interactivity in clinical reasoning skills acquisition in the case-based education setting. The greater efficiency observed for interactive formats is attributable to collaborative learning’s positive effects. They also call upon future research to investigate ways to improve the Live-CCD format and how instructional support can enhance video-based CCDs.


Weidenbusch, M., Lenzer, B., Sailer, M., Strobel, C., Kunisch, R., Kiesewetter, J., … & Zottmann, J. M. (2019). Can clinical case discussions foster clinical reasoning skills in undergraduate medical education? A randomized controlled trial. BMJ Open9(9), e025973.


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