{"id":72798,"date":"2025-03-18T09:46:10","date_gmt":"2025-03-18T01:46:10","guid":{"rendered":"https:\/\/medicine.nus.edu.sg\/taps\/?post_type=issues&#038;p=72798"},"modified":"2025-07-01T08:53:44","modified_gmt":"2025-07-01T00:53:44","slug":"effective-methods-of-teaching-clinical-reasoning-in-paediatrics-a-scoping-review","status":"publish","type":"issues","link":"https:\/\/medicine.nus.edu.sg\/taps\/issues\/effective-methods-of-teaching-clinical-reasoning-in-paediatrics-a-scoping-review\/","title":{"rendered":"Effective methods of teaching clinical reasoning in paediatrics: A scoping review"},"content":{"rendered":"<p>Submitted: 7 April 2024<br \/>\r\nAccepted: 5 February 2025<br \/>\r\nPublished online: 1 April, TAPS 2025, 10(2), 34-45<br \/>\r\n<a href=\"https:\/\/doi.org\/10.29060\/TAPS.2025-10-2\/RA3272\">https:\/\/doi.org\/10.29060\/TAPS.2025-10-2\/RA3272<\/a><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Jasmin<sup> <\/sup>Oezcan<sup>1<\/sup>, Marcus A. Henning<sup>2<\/sup> &amp; Craig S. Webster<sup>2<\/sup><\/span><\/p>\r\n<p style=\"text-align: justify;\"><i><sup><span lang=\"EN-GB\">1<\/span><\/sup><\/i><i><span lang=\"EN-GB\">Pediatric Department, Erlangen University Hospital, Erlangen, Germany; <sup>2<\/sup>Centre for Medical and Health Sciences\u00a0Education, School of Medicine, University of Auckland, New Zealand<\/span><\/i><\/p>\r\n<p style=\"text-align: center;\"><b><span lang=\"EN-GB\">Abstract <\/span><\/b><\/p>\r\n<p style=\"text-align: justify;\"><b><span lang=\"EN-GB\">Introduction:<\/span><\/b><span lang=\"EN-GB\"> Paediatric practice presents unique challenges for clinical reasoning, including <\/span><span lang=\"EN-GB\">the collection of clinical information from multiple individuals during history taking, often in emotionally charged circumstances, and the variable presentation of signs and symptoms due to the developmental stage of the child. <\/span><span lang=\"EN-GB\">Communication skills are clearly important but the most effective methods of teaching clinical reasoning in paediatrics remains unclear. Our <\/span><span lang=\"EN-GB\">review aimed to examine the existing methods of teaching clinical reasoning in paediatrics, and to consider the evidence for the most effective approaches.<\/span><span lang=\"EN-GB\"><\/span><\/p>\r\n<p style=\"text-align: justify;\"><b><span lang=\"EN-GB\">Methods:<\/span><\/b><span lang=\"EN-GB\"> We performed a scoping review and evidence synthesis drawn from reports found during a systematic search in five major databases. We reviewed 211 reports to include 11.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><b><span lang=\"EN-GB\">Results:<\/span><\/b><span lang=\"EN-GB\"> Students who received explicit training in clinical reasoning showed a significant improvement in their experiential learning, diagnostic ability, and reflective clinical judgement. More specifically, key findings demonstrated <\/span><span lang=\"EN-GB\">frequent student-centered interactive strategies increased awareness of the critical role of communication skills and <\/span><span lang=\"EN-GB\">medical history taking. <\/span><span lang=\"EN-GB\">R<\/span><span lang=\"EN-GB\">eal case-based exercises, flipped classrooms, workshops, team-based or\/and bed-side teaching, and clinical simulation involving multisource feedback were effective in improving student engagement and performance on multiple outcome measures.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><b><span lang=\"EN-GB\">Conclusion:<\/span><\/b><span lang=\"EN-GB\"> This review provides a structured insight into the advantages of different teaching methods, focusing on the multistep decision process involved in teaching clinical reasoning in paediatrics. Our <\/span><span lang=\"EN-GB\">review demonstrated a relatively small number of studies in paediatrics related to clinical reasoning, underlining the need for further research and curricular developments that may better meet the known unique challenges of the care of paediatric patients.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><b><span lang=\"EN-GB\">Keywords<\/span><\/b><b><span lang=\"EN-GB\">:<\/span><\/b><span lang=\"EN-GB\">\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <i>Clinical Reasoning, Paediatrics, Teaching Methods, Medical Students<\/i><\/span><\/p>\r\n<p align=\"center\"><strong><span lang=\"EN-GB\">Practice Highlights <\/span><\/strong><\/p>\r\n<ul>\r\n\t<li style=\"text-align: justify;\"><span lang=\"EN-GB\"> <\/span><span lang=\"EN-GB\">Clinical reasoning in paediatrics involves unique challenges including the collection of clinical information from multiple people (child, parents and care givers), symptoms that may present differently due to children\u2019s stage of development, and complex pharmacokinetics.<\/span><\/li>\r\n\t<li style=\"text-align: justify;\"><span lang=\"EN-GB\"> <\/span><span lang=\"EN-GB\">The efficacy of paediatric training could be increased by combining student-centered methods like flipped-classroom, team-based or bed-side teaching and simulation.<\/span><\/li>\r\n\t<li style=\"text-align: justify;\"><span lang=\"EN-GB\"> <\/span><span lang=\"EN-GB\">Low stakes training such as simulation that allows repetition and learning from mistakes is particularly effective and engaging for students.<\/span><\/li>\r\n\t<li style=\"text-align: justify;\"><span lang=\"EN-GB\"> <\/span><span lang=\"EN-GB\">Our <\/span><span lang=\"EN-GB\">review demonstrated a relatively small number of studies specifically related to clinical reasoning in paediatrics, underlining the need for further research and curricular developments that may better meet the known unique challenges of the care of paediatric patients.<\/span><\/li>\r\n<\/ul>\r\n<div>\r\n<p align=\"center\"><strong><span lang=\"EN-GB\">I. <\/span><span lang=\"EN-GB\">INTRODUCTION <\/span><\/strong><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Reflective diagnostic skills, comprising the analyses of symptoms and health issues and the weighing up of alternative explanations, are essential for establishing a correct diagnosis and for successful treatment and patient management. In addition, it is important to acknowledge that conscious and unconscious biases may be associated with human errors underlining clinical decision-making (Croskerry, 2005; Webster, Taylor, et al., 2021). The prevalence of incorrect acute clinical diagnosis has been estimated at 5-15% and emphasises the importance of understanding and minimising reasoning errors (Scott, 2009). It has been estimated that 75% of diagnostic errors may be associated with problems of clinical reasoning, in particular related to failures to elicit, synthesise, decide, or act on clinical information (Graber et al., 2005; Pennaforte et al., 2016). <\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Clinical reasoning requires a competent and highly developed cognitive process, which can use experiential and formal knowledge to work through a cluster of symptoms to generate a correct diagnosis (Pinnock &amp; Welch, 2014). A general approach should incorporate comprehensive problem-solving and involves the need for clear questioning to discern a set of viable differential diagnoses while remaining mindful of the potential of bias in the decision-making process (Pinnock et al., 2021).<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">The practice of paediatric medicine, however, presents particular challenges for a careful, question-based process of differential diagnosis. Taking a medical history typically requires the collection of clinical information from multiple individuals, including parents, caregivers and the child themselves, often in emotionally charged circumstances. In addition, symptoms in children and neonates can be subtle and unclear \u2013 children often have limited communication abilities, their symptoms may present differently depending on their stage of development, many diagnostic tools and tests are designed for adults and have limited utility in children, and children may have unexpected sensitivities and responses to medications due to having pharmacokinetics that are very different to those of adults (Webster, Anderson, et al., 2021). <\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Despite these challenges, the teaching and experience of clinical reasoning for trainees in paediatrics is often informal and occurs in an unstructured way throughout clinical attachments. In addition, there is often a lack of opportunity to review performance with an experienced clinician, which hinders the development of insight regarding common causes of errors (Lee et al., 2010; Schmidt &amp; Mamede, 2015). It is well known that quality supervision and feedback leads to better learning in trainees, however, there is often a shortage of appropriately qualified paediatricians able to provide such supervision and feedback (de Jong &amp; Ferguson-Hessler, 1996; Zhang et al., 2019). <\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">The medical curriculum typically focuses on the acquisition of content knowledge, cultivating both theory and practical skills, which culminates in the ability to develop a treatment strategy for the patient (Norman, 2005). Clinical reasoning can be described as a multistep process consisting of: data gathering; the proposal of a diagnosis from a range of possible different hypotheses, and the reevaluation of that proposal in light of new information. <\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Early approaches to the teaching of diagnostic reasoning included the hypothetico-deductive procedural method that involved establishing a series of hypotheses, which then required the gathering of selective patient data to confirm or rule out the hypotheses being made (Norman, 2005; Schwartz &amp; Elstein, 2008). This approach was intended to promote an understanding of the physical development of a disease or condition, and is also known as the pathophysiological approach, and relies on hypothetico-deductive reasoning and knowledge acquisition (Page et al., 1995). Hence, this approach may not represent the most efficient way to cultivate clinically relevant skills. An alternative approach involves the explanation of an expert\u2019s reasoning as an unconscious and automatic pattern recognition process (Groen &amp; Patel, 1985; Schwartz &amp; Elstein, 2008). This can be linked with the dual-cognition theory (Marcum, 2012). It has been suggested that in 95% of case encounters, expert clinicians use the fast, automatic, and unconscious pattern recognition abilities of system 1, while system 2, which is conscious, slow and effortful, tends to be applied only in unusual and complicated cases (Fabry, 2022; Webster, Taylor, et al., 2021). Studies have underlined that both systems should be used simultaneously to ensure an efficient outcome (Pennaforte et al., 2016). Therefore, the teaching of the awareness of individual unconscious information processing and judgment is a major pedagogical challenge, particularly in potentially difficult practice domains such as paediatrics (Bargh &amp; Chartrand, 1999; Gruppen &amp; Frohna, 2002; Webster et al., 2022). <\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">It takes years to train a qualified paediatrician with accurate perception and judgment, enabling them to work effectively\u202fwith children and\u202ftheir parents, guardians, or caregivers (Gong et al., 2022). Gathering the medical history appropriately and forming an accurate diagnosis through a reliable clinical reasoning process is a critical professional competency in paediatricians, which may require specific curricular techniques to achieve. Therefore in this review we aimed to examine the existing methods of teaching clinical reasoning and diagnosis in paediatrics, and to consider the evidence for which approaches may be the most effective. <\/span><\/p>\r\n<p align=\"center\"><strong><span lang=\"EN-GB\">II. <\/span><span lang=\"EN-GB\">METHODS<\/span><\/strong><\/p>\r\n<p><i><span lang=\"EN-GB\">A. <\/span><\/i><i><span lang=\"EN-GB\">The Search Process<\/span><\/i><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">In consideration of the array and typology of available reviews, we choose the scoping review because it is a useful synthesis approach to create an overview of the salient literature and to identify key findings. A preliminary search identified no published review with an equal or comparable research question as the current work, suggesting that our scoping review may allow priorities for future investigations to be outlined, including potentially informing later systematic reviews (Grant &amp; Booth, 2009). The literature search was conducted during the period of March and April 2023, using five major databases (Pubmed, PsychInfo, Scopus, ERIC, and Google Scholar). We aimed to identify studies, without restriction of type or year of publication, reported in English or German, to capture as much of the Western thought on clinical reasoning in paediatrics as possible and to make the most of the language fluency of the authors. The search employed the PICO (Population, Intervention, Comparison and Outcome) framework and the terms listed in Table 1 (Schardt et al., 2007). These search terms were used according to the following structure, for example: \u201cmedical-student\u201d AND \u201cclinical-reasoning\u201d AND \u201cpaediatrics\u201d. The search included MeSH terms, truncations, subject headings, word variants and incorporated both American and British spellings.<\/span><\/p>\r\n<div align=\"center\">\r\n<table border=\"0\" cellspacing=\"0\" cellpadding=\"0\" style=\"width: 85.9707%;\">\r\n<tbody>\r\n<tr>\r\n<td width=\"151\" valign=\"top\" style=\"width: 25.3311%;\">\r\n<p><b><span lang=\"EN-GB\">Types of participants<\/span><\/b><\/p>\r\n<\/td>\r\n<td width=\"151\" valign=\"top\" style=\"width: 25.3311%;\">\r\n<p><b><span lang=\"EN-GB\">Types of intervention<\/span><\/b><\/p>\r\n<\/td>\r\n<td width=\"151\" valign=\"top\" style=\"width: 25.3311%;\">\r\n<p><b><span lang=\"EN-GB\">Types of comparison<\/span><\/b><\/p>\r\n<\/td>\r\n<td width=\"142\" valign=\"top\" style=\"width: 81.9334%;\">\r\n<p><b><span lang=\"EN-GB\">Types of outcomes<\/span><\/b><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"151\" valign=\"top\" style=\"width: 25.3311%;\">\r\n<p><span lang=\"EN-GB\">Medical-students, clinic*ians, experts and teachers.<\/span><\/p>\r\n<\/td>\r\n<td width=\"151\" valign=\"top\" style=\"width: 25.3311%;\">\r\n<p><span lang=\"EN-GB\">Clinical-reasoning, paediatric setting, clinical-rotation, medicine<\/span><\/p>\r\n<\/td>\r\n<td width=\"151\" valign=\"top\" style=\"width: 25.3311%;\">\r\n<p><span lang=\"EN-GB\">Types of educational system, study types and teaching methods. <\/span><\/p>\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"142\" valign=\"top\" style=\"width: 81.9334%;\">\r\n<p><span lang=\"EN-GB\">Depending on the study type the comparison of assessment and efficacy.<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<p align=\"center\"><span lang=\"EN-GB\">Table 1. PICO Framework Components<\/span><\/p>\r\n<p style=\"text-align: left;\"><i><span lang=\"EN-GB\"><\/span><\/i><i><span lang=\"EN-GB\">B. Data Analysis<\/span><\/i><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) was utilised as an evidence-based guideline for the inclusion and exclusion process, as illustrated in the flow diagram (Figure 1) (Moher et al., 2009). Author JO screened reports initially by title and abstract, with uncertainties being resolved at regular meetings with authors MAH and CSW. Those with suitable titles were placed in a citation management program (Vanhecke, 2008). We included studies that focused on teaching methods in clinical reasoning in paediatrics, in particular approaches that were intended to improve the quality of reasoning and decision making (see Figure 1 for inclusion and exclusion criteria). Author JO subsequently reviewed the references of the publications yielded by the search to identify additional relevant articles. Authors JO, MAH and CSW worked collaboratively to review and categorise each publication in terms of its quality of evidence (Eccles et al., 2001; Moher et al., 2009). The included articles were then summarised with reference to: (1) first study author, year, and country; (2) study design; (3) type of curricula; (4) assessment; and (5) key outcomes related to clinical reasoning (Table 2).<\/span><\/p>\r\n<p><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2025\/03\/RA3272-Figure-1-243x300.png\" alt=\"\" class=\"alignnone  wp-image-72840\" width=\"716\" height=\"884\" srcset=\"https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2025\/03\/RA3272-Figure-1-243x300.png 243w, https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2025\/03\/RA3272-Figure-1.png 669w\" sizes=\"auto, (max-width: 716px) 100vw, 716px\" \/><\/p>\r\n<p align=\"center\"><span lang=\"EN-GB\">Figure 1. Flow diagram used in search strategy: PRISMA flow chart<\/span><\/p>\r\n<p style=\"text-align: center;\"><span lang=\"EN-GB\"><\/span><strong><span lang=\"EN-GB\">III. RESULTS<\/span><\/strong><\/p>\r\n<p style=\"text-align: left;\"><i><span lang=\"EN-GB\"><\/span><\/i><i><span lang=\"EN-GB\">A. Summary of Search Strategy<\/span><\/i><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">The primary literature search generated the most results from Pubmed, Scopus and Google Scholar (Pubmed n=129, Scopus n=28 and Google Scholar n=50). Search results after the first 5 pages on Google Scholar were not considered for inclusion as these pages contained no relevant reports. After the exclusion of duplicates and screening at the title and abstract levels, the application of the inclusion and exclusion criteria upon reading the full text of candidate papers resulted in a further 11 reports being excluded on the basis that they did involve <\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">medical students, clinical contexts or had their full texts available. Eleven studies were admitted to the final scoping review (Figure 1). <\/span><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Table 2 illustrates an overview of each included study. The curriculum was classified based on the teaching methodology described by Fabry et al. (2022), which entailed dividing the typology into group size and didactic principles, i.e., flipped classroom or bed-side teaching. Due to multifaceted teaching concepts, some studies are included under more than one subheading.<\/span><\/p>\r\n<div align=\"center\">\r\n<table border=\"1\" cellspacing=\"0\" cellpadding=\"0\" style=\"width: 95.3988%;\">\r\n<tbody>\r\n<tr>\r\n<td width=\"87\" valign=\"top\" style=\"width: 17.7905%;\">\r\n<p><b><span lang=\"EN-GB\">First author (year, country) <\/span><\/b><span lang=\"EN-GB\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"77\" valign=\"top\" style=\"width: 14.0603%;\">\r\n<p><b><span lang=\"EN-GB\">Study design <\/span><\/b><span lang=\"EN-GB\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"85\" valign=\"top\" style=\"width: 16.2123%;\">\r\n<p><b><span lang=\"EN-GB\">Type of Curriculum\u00a0 <\/span><\/b><span lang=\"EN-GB\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"78\" valign=\"top\" style=\"width: 21.6062%;\">\r\n<p><b><span lang=\"EN-GB\">Assessment <\/span><\/b><span lang=\"EN-GB\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"261\" valign=\"top\" style=\"width: 81.5922%;\">\r\n<p><b><span lang=\"EN-GB\">Key outcome<\/span><\/b><span lang=\"EN-GB\"><\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"87\" valign=\"top\" style=\"width: 17.7905%;\">\r\n<p><b><span lang=\"EN-GB\">Gong et al., (2022) <\/span><\/b><span lang=\"EN-GB\"><\/span><\/p>\r\n<p><b><span lang=\"EN-GB\">China <\/span><\/b><span lang=\"EN-GB\"><\/span><\/p>\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"77\" valign=\"top\" style=\"width: 14.0603%;\">\r\n<p><span lang=\"EN-GB\">Randomised-Controlled<\/span><\/p>\r\n<\/td>\r\n<td width=\"85\" valign=\"top\" style=\"width: 16.2123%;\">\r\n<p><span lang=\"EN-GB\">Bedside teaching; team-based learning<\/span><\/p>\r\n<\/td>\r\n<td width=\"78\" valign=\"top\" style=\"width: 21.6062%;\">\r\n<p><span lang=\"EN-GB\">Computer-based case simulation; Mini-CEX; Questionnaire <\/span><\/p>\r\n<\/td>\r\n<td width=\"261\" valign=\"top\" style=\"width: 81.5922%;\">\r\n<p><span lang=\"EN-GB\">Creating a role shift to support and develop awareness of diagnostic steps and team-based mutual critical thinking. <\/span><\/p>\r\n<p><span lang=\"EN-GB\">Significant improvement of satisfaction, clinical judgement, counseling skills in favor of the intervention group. <\/span><\/p>\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"87\" valign=\"top\" style=\"width: 17.7905%;\">\r\n<p><b><span lang=\"EN-GB\">Bye et al., (2009) <\/span><\/b><span lang=\"EN-GB\"><\/span><\/p>\r\n<p><b><span lang=\"EN-GB\">University of Sydney, Australia <\/span><\/b><span lang=\"EN-GB\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"77\" valign=\"top\" style=\"width: 14.0603%;\">\r\n<p><span lang=\"EN-GB\">Randomised-Crossover <\/span><\/p>\r\n<\/td>\r\n<td width=\"85\" valign=\"top\" style=\"width: 16.2123%;\">\r\n<p><span lang=\"EN-GB\">Interactive lecture vs. computerised tutorial.<\/span><\/p>\r\n<\/td>\r\n<td width=\"78\" valign=\"top\" style=\"width: 21.6062%;\">\r\n<p><span lang=\"EN-GB\">Expert Observation; Questionnaire<\/span><\/p>\r\n<\/td>\r\n<td width=\"261\" valign=\"top\" style=\"width: 81.5922%;\">\r\n<p><span lang=\"EN-GB\">Interactive lecture was perceived as being more enjoyable, more effective in teaching clinical reasoning than observation. <\/span><\/p>\r\n<p><span lang=\"EN-GB\">Face-to-face teaching considered critical to maximising the value of computer-assisted self-learning.<\/span><\/p>\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"87\" valign=\"top\" style=\"width: 17.7905%;\">\r\n<p><b><span lang=\"EN-GB\">Yousefichaijan et al., (2016) <\/span><\/b><span lang=\"EN-GB\"><\/span><\/p>\r\n<p><b><span lang=\"EN-GB\">Amir Kabir Hospital, Iran<\/span><\/b><span lang=\"EN-GB\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"77\" valign=\"top\" style=\"width: 14.0603%;\">\r\n<p><span lang=\"EN-GB\">Semi-experimental study<\/span><\/p>\r\n<\/td>\r\n<td width=\"85\" valign=\"top\" style=\"width: 16.2123%;\">\r\n<p><span lang=\"EN-GB\">Workshop <\/span><\/p>\r\n<\/td>\r\n<td width=\"78\" valign=\"top\" style=\"width: 21.6062%;\">\r\n<p><span lang=\"EN-GB\">Clinical-reasoning tests (Diagnostic Thinking Inventory (DTI), Key Features and Clinical Reasoning Problems)<\/span><\/p>\r\n<\/td>\r\n<td width=\"261\" valign=\"top\" style=\"width: 81.5922%;\">\r\n<p><span lang=\"EN-GB\">This study emphasises the lack of teaching concepts of medical data acquisition techniques of reasoning steps. <\/span><\/p>\r\n<p><span lang=\"EN-GB\">Effective example of repeatedly practicing clinical reasoning as a practical skill by working in small groups on illness scenarios of real medical histories.<\/span><\/p>\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"87\" valign=\"top\" style=\"width: 17.7905%;\">\r\n<p><b><span lang=\"EN-GB\">Konopasek et al., (2014) <\/span><\/b><span lang=\"EN-GB\"><\/span><\/p>\r\n<p><b><span lang=\"EN-GB\">New York-Presbyterian Hospital, Graduate Medical Education, New York, NY, USA<\/span><\/b><span lang=\"EN-GB\"><\/span><\/p>\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"77\" valign=\"top\" style=\"width: 14.0603%;\">\r\n<p><span lang=\"EN-GB\">Experimental study <\/span><\/p>\r\n<\/td>\r\n<td width=\"85\" valign=\"top\" style=\"width: 16.2123%;\">\r\n<p><span lang=\"EN-GB\">Group Objective Structured Clinical Experience (OSCE); practice of communication skills and Multi- Source Feedback (MSF)<\/span><\/p>\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"78\" valign=\"top\" style=\"width: 21.6062%;\">\r\n<p><span lang=\"EN-GB\">Questionnaire <\/span><\/p>\r\n<\/td>\r\n<td width=\"261\" valign=\"top\" style=\"width: 81.5922%;\">\r\n<p><span lang=\"EN-GB\">Studies emphasise the relationship between efficient communication skills, diagnostic accuracy, patient adherence, and positive health outcomes. Additionally this approach used problem-solving exercises based on dual-process theory. Students were instructed to consciously work through their first pattern recognition and second hypothesis-data driven clinical assumptions.<\/span><\/p>\r\n<p><span lang=\"EN-GB\">Significant improvements of self-efficacy, confidence and learning motivation in the post-training scores. <\/span><\/p>\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"87\" valign=\"top\" style=\"width: 17.7905%;\">\r\n<p><b><span lang=\"EN-GB\">Rideout &amp; Raszka (2018)<\/span><\/b><span lang=\"EN-GB\"><\/span><\/p>\r\n<p><b><span lang=\"EN-GB\">University of Vermont Children\u2019s Hospital, USA <\/span><\/b><span lang=\"EN-GB\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"77\" valign=\"top\" style=\"width: 14.0603%;\">\r\n<p><span lang=\"EN-GB\">Comparative studies<\/span><\/p>\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"85\" valign=\"top\" style=\"width: 16.2123%;\">\r\n<p><span lang=\"EN-GB\">Simulation Case (Hypovolemic Shock in a Child) <\/span><\/p>\r\n<\/td>\r\n<td width=\"78\" valign=\"top\" style=\"width: 21.6062%;\">\r\n<p><span lang=\"EN-GB\">Questionnaire and Evaluation<\/span><\/p>\r\n<\/td>\r\n<td width=\"261\" valign=\"top\" style=\"width: 81.5922%;\">\r\n<p><span lang=\"EN-GB\">Simulation of rapid critical-illness recognition, diagnostic interpretation, decision-making, management, and procedural skills with the motto: learning from your mistakes. <\/span><\/p>\r\n<p><span lang=\"EN-GB\">Improvements were noted in clinical judgement in critical situations, procedural and team skills. <\/span><\/p>\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"87\" valign=\"top\" style=\"width: 17.7905%;\">\r\n<p><b><span lang=\"EN-GB\">Bhardwaj et al., (2022)<\/span><\/b><span lang=\"EN-GB\"><\/span><\/p>\r\n<p><b><span lang=\"EN-GB\">University of Florida College of Medicine, USA<\/span><\/b><span lang=\"EN-GB\"><\/span><\/p>\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"77\" valign=\"top\" style=\"width: 14.0603%;\">\r\n<p><span lang=\"EN-GB\">Longitudinal Survey <\/span><\/p>\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"85\" valign=\"top\" style=\"width: 16.2123%;\">\r\n<p><span lang=\"EN-GB\">Script Concordance Test (SCT)<\/span><\/p>\r\n<\/td>\r\n<td width=\"78\" valign=\"top\" style=\"width: 21.6062%;\">\r\n<p><span lang=\"EN-GB\">Written Exam: Comparing the SCT to usual clinical assessments <\/span><\/p>\r\n<\/td>\r\n<td width=\"261\" valign=\"top\" style=\"width: 81.5922%;\">\r\n<p><span lang=\"EN-GB\">Significant correlations between SCT, as ambiguous evolving clinical case scenario, and improved decision-making competency and valid assessment items. <\/span><\/p>\r\n<p><span lang=\"EN-GB\">The SCT facilitated feedback and meaningful conversation about problem-solving insecurities<\/span><\/p>\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"87\" valign=\"top\" style=\"width: 17.7905%;\">\r\n<p><b><span lang=\"EN-GB\">Wright et al., (2019)<\/span><\/b><span lang=\"EN-GB\"><\/span><\/p>\r\n<p><b><span lang=\"EN-GB\">University of Western Australia<\/span><\/b><span lang=\"EN-GB\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"77\" valign=\"top\" style=\"width: 14.0603%;\">\r\n<p><span lang=\"EN-GB\">Retrospective study <\/span><\/p>\r\n<\/td>\r\n<td width=\"85\" valign=\"top\" style=\"width: 16.2123%;\">\r\n<p><span lang=\"EN-GB\">Feedback Learning Opportunities (FLO) <\/span><\/p>\r\n<\/td>\r\n<td width=\"78\" valign=\"top\" style=\"width: 21.6062%;\">\r\n<p><span lang=\"EN-GB\">Multi-source feedback\u00a0 <\/span><\/p>\r\n<\/td>\r\n<td width=\"261\" valign=\"top\" style=\"width: 81.5922%;\">\r\n<p><span lang=\"EN-GB\">Prescence of FLOs in complex cases underlines one problem: insufficient clinical information related to clinical reasoning. <\/span><\/p>\r\n<p><span lang=\"EN-GB\">Advantages shown for systematic feedback-related advice to handle diagnostic and treatment inaccuracies and the learning of alternatives<\/span><\/p>\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"87\" valign=\"top\" style=\"width: 17.7905%;\">\r\n<p><b><span lang=\"EN-GB\">Forbes &amp; Foulds (2023) <\/span><\/b><span lang=\"EN-GB\"><\/span><\/p>\r\n<p><b><span lang=\"EN-GB\">Department of Pediatrics, University of Alberta, Edmonton, Canada<\/span><\/b><span lang=\"EN-GB\"><\/span><\/p>\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"77\" valign=\"top\" style=\"width: 14.0603%;\">\r\n<p><span lang=\"EN-GB\">Comparative study <\/span><\/p>\r\n<\/td>\r\n<td width=\"85\" valign=\"top\" style=\"width: 16.2123%;\">\r\n<p><span lang=\"EN-GB\">Team-based learning (TBL) with Key Feature Questions (KFQ) <\/span><\/p>\r\n<\/td>\r\n<td width=\"78\" valign=\"top\" style=\"width: 21.6062%;\">\r\n<p><span lang=\"EN-GB\">Written and oral exam involving KFQ, OSCE and MCQ.<\/span><\/p>\r\n<p><span lang=\"EN-GB\">Anonymous evaluation<\/span><\/p>\r\n<\/td>\r\n<td width=\"261\" valign=\"top\" style=\"width: 81.5922%;\">\r\n<p><span lang=\"EN-GB\">Significant improvement in KFQ scores.<\/span><\/p>\r\n<p><span lang=\"EN-GB\">Valuable feedback on team-based approach on KFQ to progress clinical reasoning<\/span><\/p>\r\n<p><span lang=\"EN-GB\">Ability to experience mistakes and identifying \u201clearning gaps\u201d <\/span><\/p>\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"87\" valign=\"top\" style=\"width: 17.7905%;\">\r\n<p><b><span lang=\"EN-GB\">Khera et al., (2020) <\/span><\/b><span lang=\"EN-GB\"><\/span><\/p>\r\n<p><b><span lang=\"EN-GB\">McGovern Medical School at the University of Texas Health Science Center, USA<\/span><\/b><span lang=\"EN-GB\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"77\" valign=\"top\" style=\"width: 14.0603%;\">\r\n<p><span lang=\"EN-GB\">Non-experimental descriptive studies<\/span><\/p>\r\n<\/td>\r\n<td width=\"85\" valign=\"top\" style=\"width: 16.2123%;\">\r\n<p><span lang=\"EN-GB\">Skill session on writing patient assessments<\/span><\/p>\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"78\" valign=\"top\" style=\"width: 21.6062%;\">\r\n<p><span lang=\"EN-GB\">Written exam involving Pre- and post-written patient assessments<\/span><\/p>\r\n<\/td>\r\n<td width=\"261\" valign=\"top\" style=\"width: 81.5922%;\">\r\n<p><span lang=\"EN-GB\">Introduction and practice of the efficient usage of semantic qualifiers for key problem summaries.<\/span><\/p>\r\n<p><span lang=\"EN-GB\">Positive effect demonstrated when practicing the formulation, synthesising, and reviewing of potential differential diagnoses and integration of clinical reasoning. <\/span><\/p>\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"87\" valign=\"top\" style=\"width: 17.7905%;\">\r\n<p><b><span lang=\"EN-GB\">Lissinna et al., (2022) <\/span><\/b><span lang=\"EN-GB\"><\/span><\/p>\r\n<p><b><span lang=\"EN-GB\">Department of Pediatrics, University of Alberta, Edmonton Clinic, Canada<\/span><\/b><span lang=\"EN-GB\"><\/span><\/p>\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"77\" valign=\"top\" style=\"width: 14.0603%;\">\r\n<p><span lang=\"EN-GB\">Qualitative Study <\/span><\/p>\r\n<\/td>\r\n<td width=\"85\" valign=\"top\" style=\"width: 16.2123%;\">\r\n<p><span lang=\"EN-GB\">Pediatric bootcamp using flipped classroom<\/span><\/p>\r\n<\/td>\r\n<td width=\"78\" valign=\"top\" style=\"width: 21.6062%;\">\r\n<p><span lang=\"EN-GB\">Questionnaire and Evaluation<\/span><\/p>\r\n<\/td>\r\n<td width=\"261\" valign=\"top\" style=\"width: 81.5922%;\">\r\n<p><span lang=\"EN-GB\">Positive effects of pre-readings and virtual interactive illness approach on efficiency of clinical data collection, critical-thinking and new mental approach to learning strategies in low stakes environment.<\/span><\/p>\r\n<p><span lang=\"EN-GB\">Showed possible benefits from the preclinical-clinical transition. <\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"87\" valign=\"top\" style=\"width: 17.7905%;\">\r\n<p><b><span lang=\"DE\">Schmidt &amp; Grigull (2018) <\/span><\/b><span lang=\"DE\"><\/span><\/p>\r\n<p><b><span lang=\"DE\">Medizinischen Hochschule Hannover (MHH), Germany <\/span><\/b><span lang=\"DE\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"77\" valign=\"top\" style=\"width: 14.0603%;\">\r\n<p><span lang=\"EN-GB\">Qualitative Study <\/span><\/p>\r\n<\/td>\r\n<td width=\"85\" valign=\"top\" style=\"width: 16.2123%;\">\r\n<p><span lang=\"EN-GB\">Interactive Serious Game: \u201cPedagotchi,\u201d for case-based learning; blended learning<\/span><\/p>\r\n<\/td>\r\n<td width=\"78\" valign=\"top\" style=\"width: 21.6062%;\">\r\n<p><span lang=\"EN-GB\">Questionnaire <\/span><\/p>\r\n<p><span lang=\"EN-GB\">System Usability Scale (SUS) and User Experience Questionnaire (UEQ)<\/span><\/p>\r\n<\/td>\r\n<td width=\"261\" valign=\"top\" style=\"width: 81.5922%;\">\r\n<p><span lang=\"EN-GB\">Motivational and digital additions to traditional lectures. Improved dialogue, real-time feedback and practice of clinical-reasoning in a low-stakes environment. <\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<p align=\"center\"><span lang=\"EN-GB\">Table 2. Overview of reports included in scoping review<u><\/u><\/span><\/p>\r\n<p style=\"text-align: left;\"><i><span lang=\"EN-GB\"><\/span><\/i><i><span lang=\"EN-GB\">B. Source of Studies and Research Design<\/span><\/i><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Included studies came from 6 countries, in general being conducted at university hospitals. The largest group of included studies (n=4) originated in the USA (Bhardwaj et al., 2022; Khera et al., 2020; Konopasek et al., 2014; Rideout &amp; Raszka, 2018). Two articles came from Australia (Bye et al., 2009; Wright et al., 2019) and Canada (Forbes &amp; Foulds, 2023; Lissinna et al., 2022). Single studies were derived from China (Gong et al., 2022), Germany (Schmidt &amp; Grigull, 2018) and Iran (Yousefichaijan et al., 2016). <\/span><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">We categorised the evidence in each publication based on an established evidence hierarchy (Table 3) (Eccles et al., 2001; Jensen et al., 2004). No reviewed study could be aligned to criterion 1a, i.e., evidence from meta-analysis of randomised controlled trials. Two studies employed a randomised-control design, with Bye et al. conducting a crossover controlled design (Bye et al., 2009; Gong et al., 2022). The method of employing a quasi-experimental study was conducted by two included studies (Konopasek et al., 2014; Yousefichaijan et al., 2016). The majority of included studies could be aligned with category III, i.e., evidence from non-experimental descriptive methods, or more specifically longitudinal surveys (Bhardwaj et al., 2022), retrospective studies (Wright et al., 2019) and qualitative approaches (Forbes &amp; Foulds, 2023; Khera et al., 2020; Lissinna et al., 2022; Rideout &amp; Raszka, 2018; Schmidt &amp; Grigull, 2018).<\/span><\/p>\r\n<div align=\"center\">\r\n<table border=\"0\" cellspacing=\"0\" cellpadding=\"0\" style=\"width: 95.1894%;\">\r\n<tbody>\r\n<tr>\r\n<td width=\"302\" valign=\"top\" style=\"width: 49.8344%;\">\r\n<p><b><span lang=\"EN-GB\">Category of evidence<\/span><\/b><\/p>\r\n<\/td>\r\n<td width=\"302\" valign=\"top\" style=\"width: 120.742%;\">\r\n<p><b><span lang=\"EN-GB\">Number of studies identified on each rank<\/span><\/b><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"302\" valign=\"top\" style=\"width: 49.8344%;\">\r\n<p><span lang=\"EN-GB\">Ia: evidence from meta-analysis of randomised controlled trials <\/span><span lang=\"EN-GB\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"302\" valign=\"top\" style=\"width: 120.742%;\">\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"302\" valign=\"top\" style=\"width: 49.8344%;\">\r\n<p><span lang=\"EN-GB\">Ib: evidence from at least one randomised controlled trial <\/span><span lang=\"EN-GB\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"302\" valign=\"top\" style=\"width: 120.742%;\">\r\n<p><span lang=\"EN-GB\">n=2 <\/span><\/p>\r\n<p><span lang=\"EN-GB\">Gong et al., 2022; Bye et al., 2009<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"302\" valign=\"top\" style=\"width: 49.8344%;\">\r\n<p><span lang=\"EN-GB\">IIa: evidence from at least one controlled study without randomisation <\/span><span lang=\"EN-GB\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"302\" valign=\"top\" style=\"width: 120.742%;\">\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"302\" valign=\"top\" style=\"width: 49.8344%;\">\r\n<p><span lang=\"EN-GB\">IIb: evidence from at least one other type of quasi-experimental study <\/span><span lang=\"EN-GB\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"302\" valign=\"top\" style=\"width: 120.742%;\">\r\n<p><span lang=\"EN-GB\">n=2 <\/span><\/p>\r\n<p><span lang=\"EN-GB\">quasi-experimental <\/span><\/p>\r\n<p><span lang=\"EN-GB\">Yousefichaijan et al., 2016; Konopasek et al., 2014<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"302\" valign=\"top\" style=\"width: 49.8344%;\">\r\n<p><span lang=\"EN-GB\">III: evidence from non-experimental descriptive studies, such as comparative studies, correlation studies<br \/>\r\nand case-control studies <\/span><span lang=\"EN-GB\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"302\" valign=\"top\" style=\"width: 120.742%;\">\r\n<p><span lang=\"EN-GB\">n=7<\/span><\/p>\r\n<p><span lang=\"EN-GB\">Longitudinal survey: Bhardwaj et al., 2022<\/span><\/p>\r\n<p><span lang=\"EN-GB\">Qualitative study: Lissinna et al., 2022; Khera et al., 2020; Rideout &amp; Raszka, 2018; Forbes &amp; Foulds, 2023; Schmidt &amp; Grigull, 2018. <\/span><\/p>\r\n<p><span lang=\"EN-GB\">Retrospective study: Wright et al., 2019<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"302\" valign=\"top\" style=\"width: 49.8344%;\">\r\n<p><span lang=\"EN-GB\">IV: evidence from expert committee reports or opinions and \u2044 or clinical experience of respected authorities <\/span><span lang=\"EN-GB\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"302\" valign=\"top\" style=\"width: 120.742%;\">\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<p align=\"center\"><span lang=\"EN-GB\">Table 3. Included studies categorised according to levels of evidence defined by Eccles et al. (2001)<\/span><\/p>\r\n<p style=\"text-align: left;\"><i><span lang=\"EN-GB\"><\/span><\/i><i><span lang=\"EN-GB\">C. Summary based on Type of Evidence <\/span><\/i><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">The key outcomes derived from the included studies mostly focused on the principle of problem-based learning and can be framed in reference to experiential learning, such as clinical simulation and the acquisition of theoretical reasoning skills (Fabry, 2022; Jensen et al., 2004). <\/span><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<p style=\"text-align: justify;\"><i><span lang=\"EN-GB\"><\/span><\/i><i><span lang=\"EN-GB\">1) Experiential learning: <\/span><\/i><span lang=\"EN-GB\">There is evidence, based on the following studies, indicating that a team-based approach of clinical scenarios, with patients or simulated scenarios facilitate the impartation of clinical skills and critical thinking. The role shift towards student-centered learning increases the motivation to actively participate and overcome passive decision-making (Gong et al., 2022). The randomised study by Gong et al. established a division of bedside tasks (i.e., medical history, physical examination, etc.) amongst the case group students. This facilitated knowledge exchange within the team, and enabled both awareness and practice of reasoning steps. Subsequent assessment using computer-based case simulations and the Mini-CEX (Mini Clinical Evaluation Exercise) detected significant improvements in clinical judgment and counselling skills after bedside team-based learning (Gong et al., 2022). In reference to critical thinking, all of the included studies demonstrated a preference for students to encounter and use real cases involving ambiguity, symptom polymorphisms and the possibility of false leads in the context of paediactric practice (Kassirer, 2010). <\/span><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Forbes and Foulds (Forbes &amp; Foulds, 2023) found that students\u2019 evaluations of team-based learning showed that positive feedback on the ability to use the experiences of mistakes were linked with significant improvements in assessment scores using the Observed Structured Clinical Exam (OSCE). <\/span><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Similarly, a survey by Rideout and Raszka (Rideout &amp; Raszka, 2018) highlighted that increased team skills can result from feedback exchange and lead to the improvement of communication skills learnt during simulation, including working in intensive ettings and with distressed parents (Konopasek et al., 2014; Rideout &amp; Raszka, 2018). In addition, improved motivation to learn was related to learning in a low-stakes environment (Lissinna et al., 2022; Rideout &amp; Raszka, 2018; Schmidt &amp; Grigull, 2018). Wright et al. reported that student log entries underlined the advantages of feedback-related advice in handling diagnostic and treatment inaccuracies (Wright et al., 2019). <\/span><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">A technique called the Group Objective Structured Clinical Experience used by Konopasek et al. (Konopasek et al., 2014) showed benefits for the learner-centered method through the practice of communication skills in teams during the process of clinical reasoning. This approach brought together experiential learning, multisource feedback and the perspective of dual-process theory in directing students to begin with their recognition of symptoms, then consider hypotheses based on history taking, and information and feedback from multiple parties (Table 2). In a questionnaire-based evaluation such clinical problem solving demonstrated significant increases in self-efficacy and their motivation to learn data gathering techniques (Konopasek et al., 2014). <\/span><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">A further example, Khera et al. (Khera et al., 2020) focused on written patient information prioritisation by using semantic qualifiers to efficiently summarise key problems. Semantic qualifiers are bipolar descriptions of symptoms linked to distil broad medical histories (Norman, 2005). The comparison of pre- and post-intervention evaluation resulted in statistically significant increases in differential diagnosis assessment scores (Khera et al., 2020). <\/span><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Furthermore, half of the included studies identified multi-source feedback (student, teacher, patient) as being integral to the development of insight into their reasoning and decision-making processes. Feedback itself can proactively influence students\u2019 awareness about their mistakes allowing a meaningful conversation about areas of confusion. <\/span><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<p style=\"text-align: justify;\"><i><span lang=\"EN-GB\"><\/span><\/i><i><span lang=\"EN-GB\">2) Theoretical reasoning skills: <\/span><\/i><span lang=\"EN-GB\">Examples of didactic approaches included the use of short-term workshops, flipped classroom teaching, virtual learning experiences, and script-concordance tests. These teaching methods resulted in improved awareness of theory, development of knowledge structures, data prioritisation, and critical thinking (Yousefichaijan et al., 2016). More specifically, half of the studies acknowledged the incorporation of a medical data acquisition technique as being a useful approach to teaching, since diagnostic inaccuracy can be linked with a lack of accurate data gathering (Bye et al., 2009). In reference to these diagnostic techniques, the workshop of Yousefichaijan et al. is an effective example of repeatedly practicing clinical reasoning as a pragmatic skill (Yousefichaijan et al., 2016). Comparing analyses of the Diagnostic Thinking Inventory (DTI) and Clinical Reasoning Problem (CRP) showed significant advantages of working in small groups on illness scenarios (Yousefichaijan et al., 2016). Lissinna et al. (2022) employed a virtual flipped classroom exercise, and then assessed students\u2019 experiences of pre-reading and their practice of efficient sorting of clinically relevant data via semi-structured interviews. The concept of Blended-Learning, as a combination of digital and traditional teaching, embodies the Serious Game approach of Schmidt et al. (2018). The complementary results of Bye et al.\u2019s comparative study, which focused on interactive versus computerised methods of pedagogy, underlines the advantages of the digital addition in the practice of interactive case-based learning with real-time feedback (Bye et al., 2009). In consideration of the aforementioned aspects, the implementation of the Script-Concordance Test that assesses case training, can reveal several advantageous measurements, related to pedagogical techniques using case-based and feedback methods and thus can be regarded as a valid assessment tool (Bhardwaj et al., 2022). <i><\/i><\/span><\/p>\r\n<p style=\"text-align: center;\"><strong><span lang=\"EN-GB\">IV. DISCUSSION<\/span><\/strong><\/p>\r\n<p style=\"text-align: left;\"><i><span lang=\"EN-GB\"><\/span><\/i><i><span lang=\"EN-GB\">A. Clinical Reasoning \u2013 A Complex Practical Skill <\/span><\/i><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">The findings from this scoping review affirm that clinical reasoning can be described as the mediatory link influencing a clinician\u2019s cognitive multistep process. This process involves knowledge organisation, efficient data gathering, critical data integration culminating in generating a set of reasonable hypotheses, to finally achieve accurate diagnostic interpretation and reflection (Lissinna et al., 2022; Pennaforte et al., 2016; Pinnock et al., 2021). From a data driven perspective, used by novice learners, teaching these reasoning steps separately would likely impair the effectiveness of the reasoning process (Schmidt &amp; Mamede, 2015). At the moment no peer-reviewed paediatric curricula guidelines focus on active educational experience of clinical reasoning. Additionally, short paediatric rotations only allow limited practice of common paediatric diagnoses (Madduri et al., 2024).<\/span><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Consistent with Miller\u2019s pyramid of clinical competence learning clinical skills effectively, involves promoting practice by doing, along with frequent repetition (Fabry, 2022; Miller, 1990). In reference to the dual-process model, repetition moves much of the cognitive effort involved in understanding the relevant illness presentation from system 2 to the pattern recognition abilities of system 1 (Yazdani et al., 2017). Considering clinical reasoning as a practical skill, student passivity is the reason why it is relatively difficult to attain a high level of competency (Forbes &amp; Foulds, 2023). Ulfa et al. (2021) used a randomised control trial comparing lecture vs. team-based learning of postpartum hemorrhage of midwifery students. The results indicated the superiority of active team-based methods on the development of independent and effective critical-thinking abilities. This suggests substantial benefits for a paediatric curricula configuration that involves implementation of more active learning experiences starting in the pre-clinical years in the form of mixed teaching strategies (Forbes &amp; Foulds, 2023; Jost et al., 2017; Koenemann et al., 2020). Jost and colleagues observed significantly improved clinical reasoning performance with Team-Based Learning groups in an undergraduate neurology course using key-feature examination (Jost et al., 2017).<\/span><b><span lang=\"EN-GB\"> <\/span><\/b><\/p>\r\n<p style=\"text-align: justify;\"><i><span lang=\"EN-GB\">B. Mix of Teaching Methods <\/span><\/i><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">In reference to this scoping review\u2019s aim, we can identify the advantages of combining different teaching styles.<\/span><span lang=\"EN-GB\"> Lectures<b> <\/b>remain the fundamental method used to convey basic scientific knowledge, which can be an essential precondition for using more practical teaching methods. The findings indicated that improvements of the decision-making process were first identified by theory presentation, i.e., teaching dual-process theory and its links to common cognitive pitfalls and the potentially significant adverse consequences for paediatric clinical reasoning (Schmidt &amp; Mamede, 2015). However, lectures also have didactic disadvantages, which include teacher-centered explanations with less activation and linking of previous knowledge and may create cognitive overload in learners (Fabry, 2022). There are different options to overcome this by promoting active pre-class learning and open discussions about information processing ambiguities (Lissinna et al., 2022). For example, the use of the flipped classroom approach can improve clinical understanding and increase the motivation to learn in contrast to lecture-based approaches (Tang et al., 2017). The crossover study of Tan et al. (Tan et al., 2016) also indicated superior problem-solving ability attributed to team-based learning in comparison with interactive lectures. Similarly, Jackson et al. (Jackson et al., 2020) demonstrated a significant increase in satisfaction when using critical thinking and promoting student self-directed learning when attending an online team-based learning module in a family medicine rotation. <\/span><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<p style=\"text-align: justify;\"><i><span lang=\"EN-GB\"><\/span><\/i><i><span lang=\"EN-GB\">C. Clinical Reasoning and Clinical Cases<\/span><\/i><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">The simulation of clinical judgment can be enhanced using an evolving clinical scenario (Fabry, 2022). The focus on improvement of clinical judgment in paediatrics can be justified by a unique interaction of fine perception and empathy of the child\u2019s clinical problem. In particular, the practice of effective communication plays a critical role in the analyses of symptoms when in discussion with parents and children. Since both are overlaid with anxiety, this adds to the diagnostic challenge. This requires experiential learning, for example by the careful student-centered bedside practice of communication with anxious and vulnerable families. This can increase students\u2019 awareness of emotional messages and changes in the patient. The link of promoting empathy by teaching problem-solving plays a critical role in paediatrics (Gong et al., 2022). One example, could be the use of Illness scripts, describing an approach to synthesising patient history into a meaningful flowchart. Levin et al. and Konemann et al. showed students\u2019 motivation working on real complex cases embodying a step-by-step information disclosure approach (Koenemann et al., 2020; Levin et al., 2016). Interestingly, Schmidt and Mamede also described these two opposing ways to present clinical cases, calling them \u201cserial-cue\u201d vs. \u201cwhole case\u201d methods (Schmidt &amp; Mamede, 2015). The studies included in this review emphasised students\u2019 challenges with obtaining the correct collection of critical information for a stepwise disclosure in paediatrics. <\/span><i><span lang=\"EN-GB\">\u00a0<\/span><\/i><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Furthermore, the randomised trial protocol of Pennaforte et al., embodies an example of combining real-environment patient simulation and iterative discussions (Pennaforte et al., 2016). These discussion protocols appear as reminders at three key moments in time, namely data gathering, integration, and confirmation. The reminder and task verbalisation provide better insight into the dynamic systems, based on the dual-process theory. Debriefing thoughts, in the form of thinking aloud and self-explanation, could promote higher performance of active understanding, more accurate symptom correlations, deliberate reflection and especially detecting pitfalls in the reasoning process (Chamberland et al., 2015; Pennaforte et al., 2016). <\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Studies revealed the important role of appropriate and timely feedback on the overall improvement of a clinical skill (DeLeon et al., 2018; Fabry, 2022; Wright et al., 2019). Torre et al., identifies the contribution of bedside teaching and multi-source feedback (supervisor, students, and patients) as an essential part of enhancing students\u2019 perceptions and understandings of a meaningful teaching experience (Torre et al., 2005). Feedback allows access to different perspectives, which can promote learning capacity; it is clearly regarded as a positive and proactive influence on the personal development required for successful teamwork (Koenemann et al., 2020). <\/span><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">The constant reference to decision making should not be regarded as relevant only to the clinician\u2019s perspective since effective disease management in paediatric care also depends on decisions being made by the patient and the child\u2019s parents and care givers. Consequently, we also need to focus on shared decision-making and communication skills as a crucial part of such deliberation (Gay et al., 2013). Patient-centered communication includes personal factors, like empathy and authenticity, which are essential when building a trusted and authentic clinician-patient relationship. Additionally, these skills can be seen as a tool for efficiently eliciting information and in the communication of treatment information, including medication information, to parents and children (Konopasek et al., 2014; Yousefichaijan et al., 2016). Effective communication skills of this sort increase patient adherence, especially when treatment strategies are planned in consensus with the patient (Amey et al., 2017). <\/span><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<p style=\"text-align: center;\"><span lang=\"EN-GB\"><\/span><strong><span lang=\"EN-GB\">V. CONCLUSION<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Our scoping review illustrated a knowledge gap regarding the teaching of clinical reasoning as a practical skill in paediactric practice. The findings indicate that active student-centered repetition involving experiential learning would likely facilitate more effective learning during clinical reasoning in paediatrics as aligned with the following key steps. Firstly, it would facilitate activation of prior knowledge, supporting clinically relevant knowledge structure and ensuring accurate data gathering techniques. Secondly, the simulation of critical thinking is required to improve the process of reflection to reduce cognitive biases and pitfalls. And thirdly, such an approach would promote efficient communication and the development of feedback skills to overcome diagnostic and treatment inaccuracies. Despite our comprehensive search and the international representation present in the evidence-based studies included in our review, the total number of medical education studies in paediatrics related to clinical reasoning was limited, which underlines the need for further research and curricular development in this domain, particularly given the known unique challenges of the care of paediatric patients.<\/span><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<p align=\"center\"><strong><span lang=\"EN-GB\">Notes on Contributors<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Dr. Jasmin Oezcan was involved in the conceptualisation of the study, review of the literature, analysis of included reports and in the writing and revision of the manuscript.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Associate Professor Marcus A. Henning was involved in the development of the final list of papers considered for the review and in the writing and revision of the manuscript.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Associate Professor Craig S. Webster was involved in the development of the final list of papers considered for the final review, and in the writing and revision of the manuscript. <\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">All authors have read and approved the final version of the manuscript and agree to be accountable for the work and its findings.<\/span><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<p align=\"center\"><strong><span lang=\"EN-GB\">Ethical Approval<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">This manuscript comprises a scoping review of existing published reports and, therefore did not require approval from institutional review boards. <\/span><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<p align=\"center\"><strong><span lang=\"EN-GB\">Data Availability<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">All relevant quantitative data are within the manuscript.<\/span><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<p align=\"center\"><strong><span lang=\"EN-GB\">Acknowledgement<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">This work was conducted by Dr. Jasmin Oezcan as a visiting scholar at the Centre for Medical and Health Science Education, School of Medicine, University of Auckland, New Zealand. The authors also wish to thank Professor Cameron Grant, Head of the Department of Paediatrics, Child and Youth Health, for helpful insights regarding the development of teaching programs for primary care practitioners in child health and paediatrics in New Zealand. <\/span><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<p align=\"center\"><strong><span lang=\"EN-GB\">Funding<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">There is no external funding involved in this study. <\/span><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<p align=\"center\"><strong><span lang=\"EN-GB\">Declaration of Interest<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Associate Professor Marcus Henning is an Editor of The Asia Pacific Scholar. Other authors have no conflicts of interest. <\/span><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<p align=\"center\"><strong><span lang=\"EN-GB\">References<\/span><\/strong><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"EN-US\">Amey, L., Donald, K. J., &amp; Teodorczuk, A. (2017). Teaching clinical reasoning to medical students. <i>British Journal of Hospital Medicine<\/i>,<i> 78<\/i>(7), 399-401. <\/span><span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.12968\/hmed.2017.78.7.399\">https:\/\/doi.org\/10.12968\/hmed.2017.78.7.399<\/a><\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"EN-US\">Bargh, J. A., &amp; Chartrand, T. L. (1999). 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Teaching clinical reasoning to medical students: A case-based illness script worksheet approach. <i>MedEdPORTAL<\/i>,<i> 12<\/i>, Article 10445. <\/span><span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.15766\/mep_2374-8265.10445\">https:\/\/doi.org\/10.15766\/mep_2374-8265.10445<\/a><\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"EN-US\">Lissinna, B., Rashid, M., Foulds, J. L., &amp; Forbes, K. L. (2022). Embracing uncertainty: Medical student perceptions of a pediatric bootcamp developed in response to mandated changes during the pandemic. <i>BMC Medical Education<\/i>,<i> 22<\/i>(1), Article 390. <\/span><span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.1186\/s12909-022-03471-y\"><span lang=\"EN-GB\">https:\/\/doi.org\/10.1186\/s12909-022-03471-y<\/span><\/a><\/span><span lang=\"EN-GB\"><\/span><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"EN-US\">Madduri, G. B., Torwekar, E. L., Demirel, S., Durham, M., Hauff, K. I., Kaul, R., Nichols, T., Ravid, N. L., Shaner, M. A., &amp; Rassbach, C. E. (2024). CRISP: An inpatient pediatric curriculum for family medicine residents using clinical reasoning and iIllness scripts. <i>MedEdPORTAL<\/i>,<i> 20, <\/i>Article 11393. <\/span><span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.15766\/mep_2374-8265.11393\">https:\/\/doi.org\/10.15766\/mep_2374-8265.11393<\/a><\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"EN-US\">Marcum, J. A. (2012). An integrated model of clinical reasoning: Dual-process theory of cognition and metacognition. <i>Journal of Evaluation in Clinical Practice<\/i>,<i> 18<\/i>(5), 954-961. <\/span><span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.1111\/j.1365-2753.2012.01900.x\">https:\/\/doi.org\/10.1111\/j.1365-2753.2012.01900.x<\/a><\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"EN-US\">Miller, G. E. (1990). 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How to improve the teaching of clinical reasoning: A narrative review and a proposal. <i>Medical Education<\/i>,<i> 49<\/i>(10), 961-973. <\/span><span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.1111\/medu.12775\">https:\/\/doi.org\/10.1111\/medu.12775<\/a><\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"EN-US\">Schmidt, R., &amp; Grigull, L. (2018). <\/span><span lang=\"DE\">Pedagotchi: Entwicklung einer neuartigen Lernanwendung f\u00fcr die P\u00e4diatrie.\u00a0<i>Monatsschrift Kinderheilkunde, 166(3), 228-235. <\/i><\/span><span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.1007\/s00112-017-0253-9\"><span lang=\"DE\">https:\/\/doi.org\/10.1007\/s00112-017-0253-9<\/span><\/a><\/span><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"DE\">Schwartz, A., &amp; Elstein, A. (2008). <\/span><span lang=\"EN-US\">Clinical reasoning in medicine. In J. Higgs, M. Jones, S. Loftus, &amp; N. 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Mason (Ed.), <i>Pediatric Sedation Outside of the Operating Room<\/i>, 721\u2013752. <\/span><span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.1007\/978-3-030-58406-1_38\">https:\/\/doi.org\/10.1007\/978-3-030-58406-1_38<\/a><\/span><span lang=\"EN-US\"> <\/span><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"EN-US\">Webster, C. S., Taylor, S., Thomas, C., &amp; Weller, J. M. (2022). Social bias, discrimination and inequity in healthcare: Mechanisms, implications and recommendations. <i>BJA Education<\/i>,<i> 22<\/i>(4), 131-137. <\/span><span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.1016\/j.bjae.2021.11.011\">https:\/\/doi.org\/10.1016\/j.bjae.2021.11.011<\/a><\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"EN-US\">Webster, C. S., Taylor, S., &amp; Weller, J. M. (2021). Cognitive biases in diagnosis and decision making during anaesthesia and intensive care. <i>BJA Education<\/i>,<i> 21<\/i>(11), 420-425. <\/span><span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.1016\/j.bjae.2021.07.004\">https:\/\/doi.org\/10.1016\/j.bjae.2021.07.004<\/a><\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"EN-US\">Wright, H. M., Maley, M. A. L., Playford, D. E., Nicol, P., &amp; Evans, S. F. (2019). Feedback learning opportunities from medical student logs of paediatric patients. <\/span><i><span lang=\"EN-GB\">BMC Medical Education, 19<\/span><\/i><span lang=\"EN-GB\">(1), Article 107. <\/span><span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.1186\/s12909-019-1533-y\"><span lang=\"EN-GB\">https:\/\/doi.org\/10.1186\/s12909-019-1533-y<\/span><\/a><\/span><span lang=\"EN-GB\"><\/span><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"EN-US\">Yazdani, S., Hosseinzadeh, M., &amp; Hosseini, F. (2017). Models of clinical reasoning with a focus on general practice: A critical review. <i>Journal of Advances in Medical Education &amp; Professionalism<\/i>,<i> 5<\/i>(4), 177-184. <\/span><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"EN-US\">Yousefichaijan, P., Jafari, F., Kahbazi, M., Rafiei, M., &amp; Pakniyat, A. (2016). The effect of short-term workshop on improving clinical reasoning skill of medical students. <i>Medical Journal of the Islamic Republic of Iran<\/i>,<i> 30<\/i>, 396. <\/span><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"EN-US\">Zhang, Y., Huang, L., Zhou, X., Zhang, X., Ke, Z., Wang, Z., Chen, Q., Dong, X., Du, L., Fang, J., Feng, X., Fu, J., He, Z., Huang, G., Huang, S., Ju, X., Gao, L., Li, L., Li, T., \u2026 <\/span><span lang=\"EN-GB\">Sun, K. (2019). Characteristics and workload of pediatricians in China.\u00a0<i>Pediatrics, 144<\/i>(1), <\/span><span lang=\"EN-US\">e20183532<\/span><span lang=\"EN-GB\">. <\/span><span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.1542\/peds.2018-3532\"><span lang=\"EN-GB\">https:\/\/doi.org\/10.1542\/peds.2018-3532<\/span><\/a><\/span><span lang=\"EN-GB\"><\/span><\/p>\r\n<p style=\"text-align: left;\">*<span lang=\"EN-GB\">Dr. Jasmin Oezcan <\/span><br \/>\r\n<span lang=\"EN-GB\">Department of Pediatrics Erlangen<\/span><br \/>\r\n<span lang=\"EN-GB\"><span lang=\"DE\">University Hospital Erlangen<\/span>,<\/span><br \/>\r\n<span lang=\"EN-GB\"><span lang=\"DE\">Loschgestra\u00dfe 15, 91054 Erlangen, Germany<\/span>,<\/span><br \/>\r\n<span lang=\"EN-GB\">Email: <\/span><span lang=\"EN-GB\">oezcanj@yahoo.de<\/span><br \/>\r\n<br \/>\r\n<\/p>\r\n<\/div>\r\n<\/div>\r\n<\/div>\r\n<\/div>","protected":false},"featured_media":0,"parent":0,"menu_order":5,"template":"","issues_category":[16],"archive_category":[],"issue_type":[25],"volume_category":[61894],"class_list":["post-72798","issues","type-issues","status-publish","hentry","issues_category-review-article","issue_type-past-issue","volume_category-volume-10-number-2-april-2025"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v26.4 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Effective methods of teaching clinical reasoning in paediatrics: A scoping review - The Asia Pacific Scholar<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/medicine.nus.edu.sg\/taps\/issues\/effective-methods-of-teaching-clinical-reasoning-in-paediatrics-a-scoping-review\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Effective methods of teaching clinical reasoning in paediatrics: A scoping review - The Asia Pacific Scholar\" \/>\n<meta property=\"og:description\" content=\"Submitted: 7 April 2024 Accepted: 5 February 2025 Published online: 1 April, TAPS 2025, 10(2), 34-45 https:\/\/doi.org\/10.29060\/TAPS.2025-10-2\/RA3272 Jasmin Oezcan1, Marcus A. Henning2 &amp; Craig S. Webster2 1Pediatric Department, Erlangen University Hospital, Erlangen, Germany; 2Centre for Medical and Health Sciences\u00a0Education, School of Medicine, University of Auckland, New Zealand Abstract Introduction: Paediatric practice presents unique challenges for [&hellip;]\" \/>\n<meta property=\"og:url\" content=\"https:\/\/medicine.nus.edu.sg\/taps\/issues\/effective-methods-of-teaching-clinical-reasoning-in-paediatrics-a-scoping-review\/\" \/>\n<meta property=\"og:site_name\" content=\"The Asia Pacific Scholar\" \/>\n<meta property=\"article:modified_time\" content=\"2025-07-01T00:53:44+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2025\/03\/RA3272-Figure-1-243x300.png\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data1\" content=\"34 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/medicine.nus.edu.sg\/taps\/issues\/effective-methods-of-teaching-clinical-reasoning-in-paediatrics-a-scoping-review\/\",\"url\":\"https:\/\/medicine.nus.edu.sg\/taps\/issues\/effective-methods-of-teaching-clinical-reasoning-in-paediatrics-a-scoping-review\/\",\"name\":\"Effective methods of teaching clinical reasoning in paediatrics: A scoping review - The Asia Pacific Scholar\",\"isPartOf\":{\"@id\":\"https:\/\/medicine.nus.edu.sg\/taps\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\/\/medicine.nus.edu.sg\/taps\/issues\/effective-methods-of-teaching-clinical-reasoning-in-paediatrics-a-scoping-review\/#primaryimage\"},\"image\":{\"@id\":\"https:\/\/medicine.nus.edu.sg\/taps\/issues\/effective-methods-of-teaching-clinical-reasoning-in-paediatrics-a-scoping-review\/#primaryimage\"},\"thumbnailUrl\":\"https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2025\/03\/RA3272-Figure-1-243x300.png\",\"datePublished\":\"2025-03-18T01:46:10+00:00\",\"dateModified\":\"2025-07-01T00:53:44+00:00\",\"breadcrumb\":{\"@id\":\"https:\/\/medicine.nus.edu.sg\/taps\/issues\/effective-methods-of-teaching-clinical-reasoning-in-paediatrics-a-scoping-review\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/medicine.nus.edu.sg\/taps\/issues\/effective-methods-of-teaching-clinical-reasoning-in-paediatrics-a-scoping-review\/\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\/\/medicine.nus.edu.sg\/taps\/issues\/effective-methods-of-teaching-clinical-reasoning-in-paediatrics-a-scoping-review\/#primaryimage\",\"url\":\"https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2025\/03\/RA3272-Figure-1.png\",\"contentUrl\":\"https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2025\/03\/RA3272-Figure-1.png\",\"width\":669,\"height\":825},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/medicine.nus.edu.sg\/taps\/issues\/effective-methods-of-teaching-clinical-reasoning-in-paediatrics-a-scoping-review\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/medicine.nus.edu.sg\/taps\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Effective methods of teaching clinical reasoning in paediatrics: A scoping review\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/medicine.nus.edu.sg\/taps\/#website\",\"url\":\"https:\/\/medicine.nus.edu.sg\/taps\/\",\"name\":\"The Asia Pacific Scholar\",\"description\":\"\",\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\/\/medicine.nus.edu.sg\/taps\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"en-US\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Effective methods of teaching clinical reasoning in paediatrics: A scoping review - The Asia Pacific Scholar","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/medicine.nus.edu.sg\/taps\/issues\/effective-methods-of-teaching-clinical-reasoning-in-paediatrics-a-scoping-review\/","og_locale":"en_US","og_type":"article","og_title":"Effective methods of teaching clinical reasoning in paediatrics: A scoping review - The Asia Pacific Scholar","og_description":"Submitted: 7 April 2024 Accepted: 5 February 2025 Published online: 1 April, TAPS 2025, 10(2), 34-45 https:\/\/doi.org\/10.29060\/TAPS.2025-10-2\/RA3272 Jasmin Oezcan1, Marcus A. 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