New horizons of medical education: Developing critical and logical clinical reasoning in students

Abstract

Background. Quality management experts in medical services note with concern that despite the high energy intensity of modern medicine, the number of medical errors remains relatively high. Addressing this problem through administrative methods does not show visible effects. A concept has been proposed that one of the reasons for this paradox may be the peculiarity of clinical thinking among physicians. Objective. The aim of the study was to analyze the nature of medical errors made by young doctors (masters and interns) in diagnosing common diseases in children of the Odesa region of Ukraine. Material and Methods. In the analysis of errors, deductive and inductive methods were used, as well as methods of formal logic. 115 case histories were studied. Erroneous conclusions were revealed in 109 cases (94.78%). Results. The rating of erroneous conclusions by masters identified the structure of the "imaginary logical connection" - non sequitur (Latin) as the most common type, made by 42 respondents (36.52%). The next three places were taken by other reasoning structures: 2 - "After that, it means because of that" - post hoc ergo propter hoc: 28 respondents (24.35%); 3 - "Reasoning in a circle" - idem per idem: 23 responses (20.00%); 4 - verbal tricks, which are "ethically controversial rhetorical techniques": 16 responses (13.91%).

Analysis of 109 erroneous logical conclusions for compliance with the four laws of logic showed that the first law, "The law of identity," was violated 53 times (48.62%), the second law, "The law of contradiction," was violated 29 times (26.61%), the third, "The law of the excluded middle," was violated 18 times (16.51%), and the fourth, "The law of sufficient reason," was violated 9 times (8.26%).

Conclusions. It was concluded that the clinical disciplines program should include a systemic cognitive process—teaching critical thinking skills. Critical thinking in medicine is a systematic cognitive process, the training of which allows a doctor to accurately carry out a series of logical conclusions, integrate knowledge from fundamental disciplines, and minimize cognitive errors.