Generic reflective feedback: an effective approach to developing clinical reasoning skills

Problem-based learning can be an effective tool to develop clinical reasoning skills. However, it traditionally takes place in tutorial groups, giving students little flexibility in how and when they learn. This pilot study compared the effectiveness of generic reflective feedback (GRF) with tutorial-based reflective feedback on the development of students' clinical reasoning skills. Case studies were placed in an interactive software package, with GRF for the nine patient cases (36 GRF forms in total). The GRF contained information about common mistakes and omissions made by students in previous years. By design, the GRF left some clinical questions unanswered in order to prompt student reflection, enhance the development of their clinical reasoning skills and give the 2010 students (n = 53) greater control over the way in which they engaged with the unit. Clinical reasoning skills development, assessed by responses to the 36 parts across the 9 cases and in the relevant section of the final exam, was compared with the 2009 tutorial cohort (n = 47 students). GRF enabled student progression through each of the nine online cases with minimal tutor intervention. The cohort receiving GRF performed as well as those students engaging in tutorials with individualized feedback. GRF was associated with a significant increase in student satisfaction and flexibility in how and when they learned. We conclude that GRF enabled online enhancement of a case-based clinical reasoning unit. Further research on how GRF can optimize learning in different online settings is warranted.