School of Medicine
PhD Project Application 2017
An undergraudate medical curriculum for developing clinical
reasoning and decision-making capability in a volatile, complex,
uncertain and ambiguous (VUCA) world
Section 1 – Project Details:
Maximum 800 words, using the following headings
Rationale:
Approximately 12,000 patients die each year due to the "preventable deaths” defined as
deaths caused by a failure of diagnosing or treating a condition and deaths caused by
treatments that should never have been considered due to safety reasons1. Nearly three
quarters of these preventable deaths involved failure to act upon test results, inadequate
clinical enquiry and inappropriate drug or fluid management1. Furthermore, the majority of
deaths occurred in the elderly, the frail or those with multi-morbidity.
Traditionally diagnostic reasoning and decision-making skills have been taught throughout
the undergraduate curriculum, however most approaches have almost exclusively focused
on developing analytical approaches in the early years2. There is now greater acceptance
that intuition plays an equal, if not more importance role in the reasoning process as well as
metacognition, curiosity and conscientiousness. Furthermore, learning or working in primary
and secondary healthcare contexts is becoming increasingly more challenging
yet individuals do not appear to be practising their skills in a volatile, complex, uncertain and
ambiguous (VUCA) environments3.
The purpose of this research programme is to identify effective ways for developing intuition
and analytical reasoning during an undergraduate degree course, and critically discuss the
extent to which individuals develop the necessary skills for demonstrating
effective diagnostic decision-making in real-world VUCA environments.
Aims and methodology:
The aim of this research is to identify an effective strategy for developing intuition and
analytical reasoning across an undergraduate curriculum, and critically discuss the extent to
which individuals develop the necessary skills for demonstrating
effective diagnostic decision-making in VUCA environments.
By completing the objectives below, the aim for this research porogramme will be achieved:
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Undertake a (systematic) literature review to characterise teaching approaches for
developing intuition and analytical reasoning skills among students undertaking
a problem-solving or decision-making task in an undergraduate context
Explore the self-evaluations of medical students about the development
of intuition and analytical reasoning skills across the early years of the course
Explore the self-evaluations of faculty about the development
of intuition and analytical reasoning skills among medical students in the
early years of the course
Explore the way in which medical students make sense of the VUCA environment as
they undertake a diagnostic decision-making task in order to complete a clinical
enquiry safely and effectively
Feedback on the cognitive mapping and self-regulatory behaviours of medical
students as they undertake a diagnostic decision-making task novices in a VUCA
environment
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School of Medicine
PhD Project Application 2017
The research question for the overall programme of work is: ‘To what extent do novices use
intuition and analytical reasoning when undertaking diagnostic decision-making
task in a VUCA clinical environment?’
The research will be conducted through the lens of pragmatism since the phenomenon
(diagnostic decision-making) under investigation is underpinned by dual informationprocessing pathways, so a combination of research methods will be necessary to investigate
intuition and analytic reasoning respectively. Multiple factors from the external
world affecting the reasoning process (such as the history taking and test results) are also
perceived or interpreted differently between individuals requiring a flexible methodological
approach depending on the focus of the research.
The programme of research begins with a literature review to characterise teaching
approaches for developing intuition and analytical reasoning skills in an undergraduate
context and identify the effectiveness of these for improving problem-solving or decisionmaking skills among novice or intermediate students. The body of the research programme
explores self-evaluations of intuition and analytical reasoning skills development over time
from the perspectives of novices, triangulated by the views of experts.
An ethnographic4 exploration of the VUCA environment in which the diagnostic decisionmaking task takes place also contributes to the process of triangulating other findings from
the research.
The final phase of the research investigates use of cognitive mapping for identifying
inductive and deductive reasoning used by novices undertaking a diagnostic decisionmaking task in a VUCA environment and the construction of a feedback model for giving
information about self-regulated learning and changing future learning outcomes.
Benefits and suitability as a PhD project:
The benefits and suitability of this programme of research as a PhD project include:
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an opportunity to re-conceptualise the way in which clinical diagnostic decisionmaking is taught in medical education by drawing insights from other disciplines and
shape the future directions of research for others
findings that will underpin the design of a clinical diagnostic decision-making
vertical theme in the new BM BS curriculum at Nottingham and change the way in
which existing educators support novices to learn intuition and analytical reasoning
skills
inform policy for developing clinical diagnostic decision-making expertise across the
continuum of medical education including postgraduate and continuing medical
practice contexts
The supervision team for this PhD project possess a national profile as experts in clinical
reasoning and clinical diagnostic decision-making with the UK.
Key References:
1. Hogan, H., Healey, F., Neale, G., Thomson, R., Vincent, C., & Black, N. (2012). Preventable
deaths due to problems in care in English acute hospitals: a retrospective case record review
study. BMJ quality & safety, bmjqs-2012.
2. Patel, R., Sandars, J., & Carr, S. (2015). Clinical diagnostic decision-making in real
life contexts: A trans-theoretical approach for teaching: AMEE Guide No. 95. Medical
teacher, 37(3), 211-227.
3. Sandars, J., & Patel, R. (2015). Self‐regulated learning: the challenge of learning in
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School of Medicine
PhD Project Application 2017
clinical settings. Medical education, 49(6), 554-555
4. Jowsey, T. (2016). Watering down ethnography. BMJ quality & safety, 25(7), 554555.
Section 2 – Training Provision:
Maximum of 250 words. Please detail the training provision that will be made
available to the student.
The training provision within this PhD studentship include:
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Local training opportunities to better understand the discipline of medical education
include attendance on the taught course modules within the newly reformed
MMEdSci in Medical Education course such as:
o Problem-Based Learning, Case-Based Learning and Clinical Diagnostic
Decision-Making
o Learning in Complex and Uncertain Clinical Environments
o Medical Education Research, Methods and Dissertation
Local and national training opportunities to better understand and master research
methodologies and methods within medical education include:
o Cognitive mapping
o Intepretative phenomenological analysis
o Realist synthesis
o Applied linguistics
o Systematic review
o Ethnography
Local training opportunities to better understand and master research methodologies
and methods within medicine include:
o Nottingham’s nTRANS and MRes generic research training programmes
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