Medical Education Emphasizes Critical Thinking Skills

December 27, 2016

Second-year osteopathic medical students take part in CRIBS, an active learning course which teaches the kind of critical thinking they will need as practitioners.

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During their second year, osteopathic medical students at Georgia Campus – Philadelphia College of Osteopathic Medicine (GA-PCOM) participate in an active learning course known as CRIBS, which specifically teaches the kind of critical thinking skills students will need as practitioners. Short for Clinical Reasoning in Basic Science, CRIBS is a problem-solving class where students work in groups and model the steps they would take to diagnose and manage a patient.

CRIBS is not unique to GA-PCOM. It is also taught on the Philadelphia campus and at other medical schools. The diagnostic reasoning skills fostered in CRIBS on both campuses have always been a part of medical education, however the team-based learning fostered in CRIBS on the Georgia campus has only recently been used in medical school curricula.

In the course, students working in small groups are presented with a hypothetical patient case and given the patient’s chief complaint, medical history and physical exam findings. Based on this information, student groups develop a differential diagnosis, and determine which diagnostic tests are necessary to make a definitive diagnosis. Results of diagnostic tests are then supplied to the groups, and they come up with a final diagnosis and develop a management plan for the patient.

Student groups do not simply determine pharmacologic treatment, but are asked to consider osteopathic manipulative treatment when applicable. They are also asked to think holistically about how to mitigate the patient’s risk behaviors and to engage other healthcare providers as necessary to ensure the patient receives optimal care. Throughout this process, students are assisted by faculty members who guide their thought processes. Finally, after completing each case, the student groups explore the elements of basic science at the center of each case. In this way, a clear link is made between the basic and clinical sciences.

“CRIBS challenges us to start thinking like physicians,” said Francesca DiSantis (DO ’19). “It requires us to integrate the knowledge we learn in class in order to reach a final diagnosis. I believe it helps us to better understand the material as we see it applied to realistic situations.”

“Another great aspect of the CRIBS course is that [students] have the opportunity to work together as colleagues,” DiSantis added. “We are able to bounce ideas off of each other and share different viewpoints. At the end of each session we present the case, allowing us to improve our presentation skills.”

This education methodology features active learning in a facilitated environment and assesses the students’ capabilities in a social setting. Students are able to develop the ability to apply basic science knowledge and use it to determine the correct diagnoses for individual patients.

Academic Development coordinator Louise Jones has witnessed the strides students make while applying their basic and clinical science knowledge to these “real-world” scenarios.

“I see active learning and high-level application of the theories and facts that students have toiled over,” she said. “This course is where they get to link all the content they have and, by making sense of it in a logical way, become confident in their emerging clinical judgment.”

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