Abstract
BACKGROUND: Clinical reasoning is critical to the medical profession and should be a central component of the medical curriculum. However, there are different explanations of how clinical reasoning works, and there is little research on how it develops during medical education. The aim of this study is to investigate factors, i.e. skills, processes and motivations, which influence clinical reasoning in medical students. METHODS: 128 data sets were included in our study. We focused on the diagnostic aspect and therefore used students' Bayesian reasoning ability in three medical case scenarios (0-3 points) as the outcome parameter. The study measures students' risk literacy (Berlin Numeracy Test, 0-4 points) as a skill, their decision-making style as an intuitive and/or rational process (Decision Styles Scale, each 1-5 points) and identifies the role of motivation (questionnaire with 5-point Likert scales) in relation to academic goals as a potential influence on clinical reasoning. We used an ordinal logistic regression model for analysis. RESULTS: Ordinal logistic regression showed that risk literacy is more important for solving medical case scenarios than students' motivation to become researchers. The chance of solving ≥ 1 scenario increased by 33% when the highest BNT score was compared to the lowest, compared to a 27% increase for the highest motivation to become a researcher. The probability of obtaining ≥ 1 point in the scenarios rose 20% when the BNT score went from three to four, indicating that highly risk-literate students have a higher ability to solve Bayesian tasks. Yet, the ability to perform Bayesian reasoning also increased consistently with growing motivation to become a researcher. CONCLUSIONS: The study highlights the importance of paying attention to medical students' risk literacy in the development of clinical reasoning, as it appears to be a critical component. Motivation also plays an important role and, accordingly, should be encouraged in medical education.