The Influence Of Clinical Specialty On The Development Of Clinical Reasoning Skills In Junior Doctors (ASM2024-360)

Background: The context specificity of clinical reasoning reflects that diverse contextual factors significantly influence doctors' reasoning. This research investigated the impact of different clinical specialities on acquiring clinical reasoning skills in junior doctors to foster the advancement of these skills.
Methods: A qualitative study employing a hermeneutic phenomenology methodology was conducted using semi-structured interviews (n=18) and post-consultation discussions (n=48). Immediate medical graduates at a main teaching hospital in Sri Lanka, working in the four main clinical specialties were enrolled in the study. The data were analysed thematically to identify the overall patterns to explain the dataset.
Findings: The application of knowledge and skills from multiple specialities enabled better clinical reasoning in contrast to the majority view that these are not transferable between specialities. Also, junior doctors often deviated from the standard approach to obtaining a clinical history, placing more emphasis on the comorbidities or the presenting complaint, based on the specialty-specific orientation. The former was associated with diagnosis orientation, a broader base of clinical reasoning, and more patient-centred care (eg. General Medicine, Pediatrics, and Gynaecology) than the latter which was oriented towards management (eg. surgery, Obstetrics).
Conclusion: Working within a particular speciality encourages a narrow focus on speciality-specific diagnoses. Certain specialities promote a diagnostic orientation, which allows for a more comprehensive form of clinical reasoning and improved patient-centred care compared to specialities that prioritize management. Therefore, trainees should be encouraged to consider differential diagnoses beyond the confines of their specific speciality, particularly in specialities that are management-oriented.