Introduction
Complex clinical decision-making requires more than just knowledge transmission; it involves developing clinical reasoning and comprehension in learners. Using education theories to inform clinical teaching practices can facilitate this process. This applied research study examined the impact of the explicit application of education theories (situated learning theory, cognitive apprenticeship theory, visible thinking and cognitive load theory), in the teaching of blood glucose level (BGL) management to final year medical students.
Methods
Pre-intern medical students (Monash University, Peninsula campus) participated in a two-part interactive lecture series on inpatient BGL management. Ten students volunteered for pre- and post-teaching case-based interviews to assess clinical decision-making strategies. The teaching approach emphasised expert visible thinking, providing students with tools to scaffold information from authentic scenarios and break down decision-making processes into observable steps, while managing cognitive load through provision of a visual reference tool. Student interviews were analysed using template-based thematic analysis.
Results
Pre-teaching interviews revealed varied baseline knowledge, but significant uncertainty in clinical decision-making, with many students relying on observations from senior clinicians without clear understanding. Post-teaching interviews demonstrated increased confidence and a deeper ability to justify decisions, particularly in terms of insulin choice and dosing. Students highlighted that the visible thinking methodology made previously obscure clinical reasoning processes more accessible, and they utilised insulin charts for reference allowing them to manage cognitive load effectively.
Discussion
This study demonstrates that visible thinking can scaffold clinical learning by making expert reasoning explicit and accessible to novice learners. Students exhibited improved decision-making, problem representation and confidence. More broadly, these findings highlight the value of education theory application to the design and delivery of clinical teaching and are pertinent across clinical disciplines.