Teaching Clinical Reasoning to Veterinary Medical Learners with a Case Example

Round 1

Reviewer 1 Report

The manuscript provides a comprehensive review of the literature and where possible provides evidence based recommendations for teaching clinical reasoning. The authors recognise the paucity of evidence specific to this subject in veterinary medicine so it would be useful to provide some suggestions for future work/studies in this field, particularly in light of the proposed recommendations for teaching instructors clinical reasoning. 

The quality of the language is generally acceptable with the exception of the sentence beginning on L539 and finishing on L542, which starts cytological examination. This sentence does not make sense

Author Response

Comments and Suggestions for Authors

The manuscript provides a comprehensive review of the literature and where possible provides evidence based recommendations for teaching clinical reasoning. The authors recognise the paucity of evidence specific to this subject in veterinary medicine so it would be useful to provide some suggestions for future work/studies in this field, particularly in light of the proposed recommendations for teaching instructors clinical reasoning. 

AU: Thanks for your comments

Comments on the Quality of English Language

The quality of the language is generally acceptable with the exception of the sentence beginning on L539 and finishing on L542, which starts cytological examination. This sentence does not make sense

AU: Thanks for spotting the removal of the start of the sentence.  Now corrected: Line 546 - 550

Reviewer 2 Report

The article addresses the importance of teaching clinical reasoning to veterinary students, emphasizing practical application rather than just theoretical understanding. Clinical reasoning, which is essential for accurate diagnosis and treatment in veterinary medicine, involves cognitive, metacognitive, social and situational activities. The review suggests that the teaching of clinical reasoning should start early in the curriculum, preferably during the pre-clinical years, and that the complexity should be gradually increased. A cow with allergic rhinitis is used as a practical example to illustrate the teaching approach. Clinical reasoning errors, which are common in both human and veterinary medicine, are often attributed to the complexity of clinical presentations and faulty cognitive processes rather than a lack of knowledge. Learning and teaching clinical reasoning is challenging due to its complexity. In this article, clinical reasoning is divided into cognitive and metacognitive activities, contextual activities and socially mediated activities. The clinical reasoning cycle, which comprises eight phases, serves as a framework for problem solving in clinical encounters. Two types of clinical reasoning are discussed, intuitive and analytic, with most clinical reasoning falling somewhere between these two types. The article emphasizes the importance of adapting clinical reasoning to different contexts and social environments and highlights the need for instructors to be trained in clinical teaching, particularly in clinical reasoning.

It also discusses the teaching of clinical reasoning in veterinary medicine. It compares learning clinical reasoning to learning a route between two cities and emphasizes the importance of both theoretical knowledge and practical experience. The role of the educator is seen as facilitating deep learning and learner-initiated inquiry and addressing challenges such as knowledge organization, data synthesis, hypothesis generation, and awareness of bias. The article outlines a simplified process of clinical reasoning applicable to the clinical encounter in veterinary medicine and emphasizes the importance of considering context and uncertainty. A standardized framework for teaching clinical reasoning is proposed, emphasizing the inclusion of reflection and complementary inquiry techniques. Teaching should take place in dedicated sessions, preferably at the beginning of the curriculum and in a phased manner. Different teaching approaches should be used and clinical reasoning should be integrated into different disciplines. Learners should be encouraged to hypothesize early in encounters, and data collection should be purposeful and hypothesis-driven.

In addition, the article discusses the importance of looking at the client-patient situation, collecting relevant data, and analyzing that data to identify key issues. Educators should guide learners in organizing and analyzing the data and help them identify important factors and relationships between signs or syndromes. The importance of teaching learners how to recognize and ignore redundant data is emphasized, leading to a higher level of clinical reasoning skills. The text also discusses the process of teaching clinical reasoning in veterinary medicine. It emphasizes the importance of problem statement, hypothesis formation, refinement of hypotheses, goal setting, action, evaluation of outcomes, and reflection on the process and learning. The role of the educator is critical in guiding learners through these steps, facilitating reflective practice, and ensuring effective teaching of clinical reasoning. The text also suggests workshops for instructors to improve their ability to teach clinical reasoning effectively. Overall, the paper provides a comprehensive framework for teaching clinical reasoning in veterinary medicine.

Overall, the article highlights the practicality of teaching clinical reasoning to learners in veterinary medicine using structured approaches and emphasizes the role of instructors in guiding learners through the different domains of clinical reasoning.

The article is very interesting for teaching and the interdisciplinary perspective is of great importance. However, some changes would be recommended.

Some sections of the text contain repetitive information or unnecessary detail. Reader reads the same information more times as the article is also very long. Streamlining the content and eliminating redundancies would make the text more concise and easier to understand.

A more concrete example at the end of the suggested steps for phased implementation of clinical reasoning in the curriculum would help readers better understand how to apply the principles of clinical reasoning in the curriculum and would be greatly appreciated.

A minor suggestion would be to enter numbers into a schematic representation of Figure 1 (1 – consider client-patient situation, 2 collect data …).

Also, from the perspective of the veterinarian involved in the teaching process and aiming to implement clinical reasoning into the curriculum, it would be very beneficial to add a sentence about the Five Skills approach and SNAPPS as included in the SMART goals to enhance understanding.

By addressing these areas, the text could become more informative, engaging and accessible to the target audience.

Author Response

The article addresses the importance of teaching clinical reasoning to veterinary students, emphasizing practical application rather than just theoretical understanding. Clinical reasoning, which is essential for accurate diagnosis and treatment in veterinary medicine, involves cognitive, metacognitive, social and situational activities. The review suggests that the teaching of clinical reasoning should start early in the curriculum, preferably during the pre-clinical years, and that the complexity should be gradually increased. A cow with allergic rhinitis is used as a practical example to illustrate the teaching approach. Clinical reasoning errors, which are common in both human and veterinary medicine, are often attributed to the complexity of clinical presentations and faulty cognitive processes rather than a lack of knowledge. Learning and teaching clinical reasoning is challenging due to its complexity. In this article, clinical reasoning is divided into cognitive and metacognitive activities, contextual activities and socially mediated activities. The clinical reasoning cycle, which comprises eight phases, serves as a framework for problem solving in clinical encounters. Two types of clinical reasoning are discussed, intuitive and analytic, with most clinical reasoning falling somewhere between these two types. The article emphasizes the importance of adapting clinical reasoning to different contexts and social environments and highlights the need for instructors to be trained in clinical teaching, particularly in clinical reasoning.

It also discusses the teaching of clinical reasoning in veterinary medicine. It compares learning clinical reasoning to learning a route between two cities and emphasizes the importance of both theoretical knowledge and practical experience. The role of the educator is seen as facilitating deep learning and learner-initiated inquiry and addressing challenges such as knowledge organization, data synthesis, hypothesis generation, and awareness of bias. The article outlines a simplified process of clinical reasoning applicable to the clinical encounter in veterinary medicine and emphasizes the importance of considering context and uncertainty. A standardized framework for teaching clinical reasoning is proposed, emphasizing the inclusion of reflection and complementary inquiry techniques. Teaching should take place in dedicated sessions, preferably at the beginning of the curriculum and in a phased manner. Different teaching approaches should be used and clinical reasoning should be integrated into different disciplines. Learners should be encouraged to hypothesize early in encounters, and data collection should be purposeful and hypothesis-driven.

In addition, the article discusses the importance of looking at the client-patient situation, collecting relevant data, and analyzing that data to identify key issues. Educators should guide learners in organizing and analyzing the data and help them identify important factors and relationships between signs or syndromes. The importance of teaching learners how to recognize and ignore redundant data is emphasized, leading to a higher level of clinical reasoning skills. The text also discusses the process of teaching clinical reasoning in veterinary medicine. It emphasizes the importance of problem statement, hypothesis formation, refinement of hypotheses, goal setting, action, evaluation of outcomes, and reflection on the process and learning. The role of the educator is critical in guiding learners through these steps, facilitating reflective practice, and ensuring effective teaching of clinical reasoning. The text also suggests workshops for instructors to improve their ability to teach clinical reasoning effectively. Overall, the paper provides a comprehensive framework for teaching clinical reasoning in veterinary medicine.

Overall, the article highlights the practicality of teaching clinical reasoning to learners in veterinary medicine using structured approaches and emphasizes the role of instructors in guiding learners through the different domains of clinical reasoning.

The article is very interesting for teaching and the interdisciplinary perspective is of great importance. However, some changes would be recommended.

AU: Thanks for your comprehensive review.

Some sections of the text contain repetitive information or unnecessary detail. Reader reads the same information more times as the article is also very long. Streamlining the content and eliminating redundancies would make the text more concise and easier to understand.

We have re-examined the text and accept that while there is some repetition, we feel it is not excessive. Further, it is compartmentalised within subheadings which we feel makes it easier for a non-expert reader to follow as these sections are more stand alone, allowing them to ‘rest and reflect’.

A more concrete example at the end of the suggested steps for phased implementation of clinical reasoning in the curriculum would help readers better understand how to apply the principles of clinical reasoning in the curriculum and would be greatly appreciated.

AU: As this is already very long manuscript, we would prefer to include details in the next of the 3 in a series related to teaching and learning clinical reasoning for veterinary medical education

A minor suggestion would be to enter numbers into a schematic representation of Figure 1 (1 – consider client-patient situation, 2 collect data …).

AU: Thanks for the comment. Now corrected (see Figure 1).

Also, from the perspective of the veterinarian involved in the teaching process and aiming to implement clinical reasoning into the curriculum, it would be very beneficial to add a sentence about the Five Skills approach and SNAPPS as included in the SMART goals to enhance understanding.

AU: Thanks for the comment.  Addressed: The five microskills in Lines 210 – 213, and SNAPPS in Lines 295 – 299.

By addressing these areas, the text could become more informative, engaging and accessible to the target audience.

AU: Thanks for the comments

Reviewer 3 Report

I liked the manuscript. The application of clinical reasoning to veterinary medicine students is essential for the development of their clinical skills. The manuscript is long and therefore may pose a challenge to readers. However, I find the information useful and appropriate.

I consider that the manuscript should be published and I have no additional comments. Congratulations to the authors

Author Response

I liked the manuscript. The application of clinical reasoning to veterinary medicine students is essential for the development of their clinical skills. The manuscript is long and therefore may pose a challenge to readers. However, I find the information useful and appropriate.

I consider that the manuscript should be published and I have no additional comments. Congratulations to the authors

AU: Thanks for the comments.