Original Publication
Open Access

A Guide to Developing Clinical Reasoning Skills in Neurology: A Focus on Medical Students

Published: August 3, 2015 | 10.15766/mep_2374-8265.10163

Included in this publication:

  • 1-Title Page.docx
  • 2-Instructor's Guide.docx
  • 3-Instructors Notes-Guide to Seminar Session 1.docx
  • 4-Instructors Notes-Instructor Supplement to Seminar Session 1.pptx
  • 5-Instructors Notes-Guide to Seminar Session 2.docx
  • 6-Instructors Notes-Instructor Supplement to Seminar Session 2.docx
  • 7-Student Handout-Seminar Session 1-Clinical Case Vignettes.docx
  • 8-Student Handout-Seminar Session 1-Approach to Lesion Localization.docx
  • 9-Student Handout-Seminar Session 1-Approach to Differential Diagnosis.docx

To view all publication components, extract (i.e., unzip) them from the downloaded .zip file.

Editor's Note: This publication predates our implementation of the Educational Summary Report in 2016 and thus displays a different format than newer publications.


Introduction: Clinical reasoning is a fundamental skill in medicine. Teaching of this important skill spans much of formal medical training and encompasses both the acquisition of medical knowledge (i.e., content-oriented learning) and the integration of sufficient clinical experience (i.e., process-oriented learning). This course incorporates clinically relevant clerkship content to deliver a process-oriented (as opposed to content-oriented) approach to learning. Methods: This course involves two 60-minute sessions distributed over the 4-week required Neurology Core Clerkship rotation at our institution. In Session 1, the instructor leads students in the generation of a framework for evaluating neurologic disease. Students are introduced to the concepts underlying clinical reasoning in neurology, including the process of lesion localization, development of categorization of the case, and differential diagnosis formation. In Session 2, students engage in a heavily peer-mediated, learner-centered approach to applying the concepts learned in Session 1 to clinical scenarios. Clinically relevant cases, either provided by the instructor or from student-driven clinical encounters, are used to apply the framework and build models for efficiently evaluating neurologic disease. Results: Approximately 1 year following implementation, the course has been exceedingly well received. Student satisfaction has been high. The course has also not negatively impacted student performance in the clerkship. National Board of Medical Examiners Neurology Shelf Exam scores were not different in the year following implementation of the course, nor were there differences in mean rating of student clinical performance as assessed by faculty and resident clinical evaluations as observed in the years prior to and following institution of the course. Discussion: Initial student feedback was largely positive and suggested the existing format was sufficient to meet the course objectives. Student participation with the noncompulsory clinical case vignettes has remained low, and additional incentives have been sought to encourage self-directed student participation. While course content is most relevant to neurology, the skills acquired are generalizable to all of medicine and are particularly applicable to the clinical clerkship.

Educational Objectives

By the end of Session 1, learners will be able to:

  1. State the key signs and symptoms that characterize the presentation of myopathy, neuropathy, neuromuscular junction, and spinal cord disorders.
  2. Use signs and symptoms synthesized from a history and physical examination to generate the most likely localization for common neurologic presentations.
  3. State the major types of pathophysiologic processes that affect the nervous system.

By the end of Session 2, learners will be able to:

  1. Generate comprehensive differential diagnoses for the most common causes of myopathy, neuropathy, neuromuscular junction, and spinal cord disorders.
  2. Interact with peers to implement this method for clinical reasoning.

Author Information

  • Roy Strowd, MD: Wake Forest School of Medicine of Wake Forest Baptist Medical Center
  • Anthony Kwan: State University of New York Downstate Medical Center College of Medicine
  • Tiana Cruz, MA: Johns Hopkins University School of Medicine
  • Charlene Gamaldo, MD: Johns Hopkins University School of Medicine
  • Rachel Salas, MD: Johns Hopkins University School of Medicine

None to report.

None to report.


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Strowd R, Kwan A, Cruz T, Gamaldo C, Salas R. A guide to developing clinical reasoning skills in neurology: a focus on medical students. MedEdPORTAL. 2015;11:10163. https://doi.org/10.15766/mep_2374-8265.10163