Abstract:

The purpose of this study was to explore thinking processes, identify thinking patterns of medical students in clinical reasoning and examine the role of subject matter and its impact. Using a three-step coding process, transcripts from a think aloud protocol completed by twelve 4th year medical students was analyzed. A grounded theory, the flow network theory of integration, emerged from the data. The theory was defined as a process of coordinating separate elements in motion to a balanced flexible whole. The flow network theory of integration showed how medical students engaged in three increasing levels of integration as they developed their clinical reasoning skills: basic integration, progressive integration, and networked integration. The theory also revealed the pivotal role that the connection among concepts played in the development of such an increasingly complex integrated network. Within such levels of integration medical students utilized four levels of thinking processes and three different thinking patterns. The thinking processes of the students included: progression in complexity, creation of knowledge clusters, active differentiation, and integration of qualifiers. These different thinking processes and patterns appeared to be similar across subject matter domains, but may vary depending on the complexity of the clinical problem or the ill-structured nature of the problem. Implications for medical students, clinicians and medical educators were discussed.