The Impact of Clinical Reasoning Curriculum on Internal Medicine Residents: A Mixed Methods Approach

Background: Clinical reasoning is a cornerstone of medical education, critical for accurate diagnosis and patient management. Teaching this skill is challenging due to its abstract nature and susceptibility to cognitive biases, such as anchoring and confirmation bias. Objective: To evaluate the impact of a structured clinical reasoning curriculum on internal medicine residents' reasoning skills, diagnostic accuracy, and perceptions. Methods: A mixed-methods study was conducted at Anne Arundel Medical Center between 2023 and 2024, involving 41 internal medicine residents across training levels. The curriculum consisted of 100 structured, case-based sessions emphasizing hypothesis generation, reasoning, and reflection. Data collection included quantitative surveys assessing confidence and perceived skill improvements, and qualitative feedback capturing resident experiences. Statistical analysis of pre- and post-intervention data and thematic analysis of qualitative responses were performed. Results: Of the 41 residents, 34 completed the survey (response rate: 82.9%). Overall, 88% were very satisfied with the curriculum, with 85.29% finding it highly relevant to clinical practice. The sessions improved diagnostic efficiency (58.82% strongly agreed), mitigated cognitive biases (52.94% strongly agreed), and enhanced confidence in avoiding diagnostic errors (55.88% strongly agreed). Qualitative feedback highlighted the benefits of collaborative discussions, structured reasoning, and practical application, while identifying areas for improvement, such as pacing and case diversity. Conclusion: The curriculum significantly enhanced residents' clinical reasoning skills, diagnostic accuracy, and academic performance, supporting its integration into internal medicine training. Further research should explore its long-term impact on patient outcomes and optimize the curriculum to address diverse learner needs.