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September 19, 2023

A Simple Shift to Improve Medical Education

Headshots of Dr. Jessica Dreicer and Dr. Andrew Parsons

School of Medicine educators are seeking to improve patient care, prevent medical mistakes and, ultimately, produce better doctors by enhancing how students are taught clinical reasoning, the process used to diagnose and treat disease.

Jessica J. Dreicer, MD, and Andrew S. Parsons, MD, MPH, are the co-directors of UVA Health’s new Clinical Reasoning Research Collaborative, which aims to foster collaboration among patients, clinicians, educators and scholars to advance understanding of clinical reasoning.

In a new paper, Dreicer, Parsons and colleagues argue that educators can enhance undergraduate medical education by distinguishing between two terms: “framework” and “schema.” These terms are often used interchangeably, but Dreicer and Parsons suggest an important distinction that could benefit young learners and help them become better clinicians.

Enhancing Medical Education

Frameworks, they argue, are external representations of one’s understanding of a topic. Frameworks can be taught and shared with others. Schema, on the other hand, describe a clinician’s or learner’s internal understanding, Dreicer and Parsons argue. Schema are unique to each person, shaped by prior experiences and knowledge. Students with an inadequate schema for thinking through a complex illness may benefit from a simple framework to help them organize their thought processes.

In their paper, Dreicer and her collaborators employ an aviation analogy to illustrate this distinction. Pilots, they note, often rely on checklists before flying. But checklists – a type of framework – do not make good pilots by themselves. Instead, pilots incorporate not just their knowledge but real-time events and prior experience in their schema – these internal thought processes let them fly and land successfully and safely in many different situations.

This fine distinction, the UVA doctors argue, can inform how educators teach and help them better prepare their students for their future careers. In turn, this will benefit patients by producing clinicians who are better equipped for clinical decision-making, helping them make correct diagnoses and determine the best courses of treatment.

“The correct understanding of framework and schema is important for teaching clinical reasoning,” Dreicer said. “With this understanding, clinician educators can carefully select a framework to build on a learner’s existing knowledge – i.e., schema.”

By focusing on how undergraduate students will ultimately apply what they learn in the clinic, educators have an important opportunity to shape young minds early on and help them become the best physicians possible, the UVA doctors argue.

“The intentional use of select frameworks for teaching may improve a learner’s knowledge organization,” Parsons said. “This is part of a larger effort to reduce diagnostic error by improving our teaching and understanding of the clinical reasoning process.

Article Published

The new paper has been published in Perspectives on Medical Education. The article is open access, meaning it is free to read.

In addition to Dreicer and Parsons, the authors are Tony Joudi, Scott Stern and Andrew P.J. Olson, and the senior author is Joseph R. Rencic.

To keep up with the latest medical research news from UVA, subscribe to the Making of Medicine blog.


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