Developing, implementing and evaluating the effectiveness of an undergraduate clinical reasoning curriculum

Khin-Htun, Swe Yin (2019) Developing, implementing and evaluating the effectiveness of an undergraduate clinical reasoning curriculum. PhD thesis, University of Nottingham.

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Clinical reasoning (CR) is a recursive, multidimensional, and complex process involving informal and formal strategies for the analysis and evaluation of patients’ information. CR skills are traditionally acquired through the experiential learning of undergraduate (UG) students during the curriculum. Recently there has been an acknowledgement of the need to explicitly teach CR. The University of Nottingham (UoN) aimed to introduce a vertically integrated CR theme. The opportunity provided by this development was used to develop, implement and evaluate this CR curriculum.


The following research questions were formulated:

1. Is CR being embedded explicitly in the curriculum?

2. How effective is this new curriculum in developing CR skills for students and teaching skills for teachers?

3. How do students learn/develop CR?

4. Does the phase of the curriculum influence the development of CR?

5. Does the curricular model influence the development of CR?

6. Does gender have any effect?


The researcher was involved in the planning, development, implementation, and evaluation of the curriculum. Both quantitative and qualitative methodologies were employed.

• The effectiveness of the CR resources, the impact of different curricular models, the phase of the curriculum and the influence of gender was measured and compared by summative assessments.

• Interviews were used to discover the CR understanding of students and teachers and to analyse learning needs.


1. The CR theme was explicitly embedded in the curriculum.

2. This curriculum was effective in developing CR skills for students and in developing the teaching skills of teachers.

3. Qualitative research revealed how students learned and developed their CR skills.

4. The curricular phase had an impact on the development of CR.

5. PBL students scored better than integrated students in the summative exam at CP1. This was not found at CP3.

6. Gender had no influence on CR.


This study contributes to the body of knowledge regarding the development, implementation and evaluation of a CR curriculum. Despite the problems associated with working with a live curriculum a CR component was successfully developed and evaluated by means of qualitative and quantitative methods. The results of the qualitative study, in particular, have contributed to the further development of the CR curriculum and have changed our educational practices.

Item Type: Thesis (University of Nottingham only) (PhD)
Supervisors: Anderson, Susan
Dennick, Reg
Keywords: Clinical reasoning skills; Medical students; Medical education
Subjects: W Medicine and related subjects (NLM Classification) > W Health professions
Faculties/Schools: UK Campuses > Faculty of Medicine and Health Sciences > School of Medicine
Item ID: 56821
Depositing User: Khin-Htun, Swe
Date Deposited: 23 Aug 2019 13:19
Last Modified: 07 May 2020 10:15

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