| CONTEXT: Clinical reasoning is central to medical practice. . However, we lack tools to identify and objectify the difficulties of clinical reasoning, and there are relatively few descriptions of remediation methods defined. Much work remains to be done to better understand how the problems manifest themselves in the clinical reasoning of students in training, but also to make these concepts more accessible to teachers. Then this will improve the quality of the identification process difficulties, and allow considering targeted and effective remediations.;PURPOSE: This research is based on the one hand, around the objectification and understanding of current practices of clinical teachers, on the other hand, around the construction and implementation of tools and processes to facilitate the process of diagnosis and remediation of difficulties in clinical reasoning.;METHODOLOGY: A qualitative research, mainly using the methods of participatory action research has been relevant to achieving our goals. The research consists of four steps: 1. An exploratory study 2. The construction and implementation of a first tool in three clinical settings 3. The development of a taxonomy of difficulties in clinical reasoning and the construction of a new tool. 4. The development of a comprehensive approach to support and train clinical teachers;RESULTS: Teachers have a quick perception, but still global and intuitive, of the potential difficulties of clinical reasoning residents. This perception does not necessarily move into pedagogical terms. We observed the absence of organized and structured pedagogical processes to manage these difficulties. This seems to project the clinical teachers in a zone of discomfort, by confronting them with a lack of control and uncertainty about their educational activities. The categorization of clinical reasoning difficulties that we have built allows identifying the problems as they occur in everyday clinical supervision. This tool, however, needs to be integrated into a larger process.;CONCLUSION: It is necessary to develop a comprehensive approach that includes faculty development process, implementation tools, vulgarization of the theory, and teacher training.;Key words: clinical reasoning process, remedial process, remediation, clinical teacher... |
