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The Six R's of Management Reasoning for Subintern Education.

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Τίτλος: The Six R's of Management Reasoning for Subintern Education.
Συγγραφείς: Maldonado M; Department of Medicine, Baylor College of Medicine, Houston, Texas, USA., Boedeker P; Department of Education, Innovation and Technology, Baylor College of Medicine, Houston, Texas, USA., Kusnoor AV; Department of Medicine, Baylor College of Medicine, Houston, Texas, USA.
Πηγή: The clinical teacher [Clin Teach] 2026 Aug; Vol. 23 (4), pp. e70462.
Τύπος έκδοσης: Journal Article
Γλώσσα: English
Στοιχεία περιοδικού: Publisher: Blackwell Pub Country of Publication: England NLM ID: 101227511 Publication Model: Print Cited Medium: Internet ISSN: 1743-498X (Electronic) Linking ISSN: 17434971 NLM ISO Abbreviation: Clin Teach Subsets: MEDLINE
Imprint Name(s): Original Publication: Oxford, UK : Blackwell Pub., c2004-
Ιατρικοί όροι (MeSH): Students, Medical*/psychology , Education, Medical*/organization & administration , Clinical Reasoning*, Humans ; Clinical Competence
Περίληψη: Background: Management reasoning (MR), the component of clinical reasoning concerned with treatment planning, patient preferences and resource considerations, develops later than diagnostic reasoning and remains underemphasised in medical education. Despite calls to explicitly teach MR, instructional strategies remain scarce.
Approach: We developed a mnemonic, the "Six R's of Management Reasoning," and implemented a 90-min workshop grounded in social constructivism. Between July 2023 and December 2024, we taught 22 sessions to 119 subinterns. Students used the mnemonic to collaboratively construct management plans and admission orders through case-based activities and facilitated discussions.
Evaluation: Using three levels of Kirkpatrick's model-reaction, learning and behaviour-we assessed the workshop through IRB-approved surveys, tests and workplace assessments. Postworkshop and postrotation surveys showed significant increases in students' confidence and ability to apply MR (all p < 0.001). Knowledge test scores improved from 81.7% to 93.3% (p < 0.001, Hedges's g = 1.20). Faculty assessments confirmed students' strengths in risk calculation and shared decision-making, though some students struggled with applying high-value care and citing evidence.
Implications: The "Six R's of Management Reasoning" provided a practical tool for MR development, and activities selected based on social constructivism were effective and well received. Mixed performance in clinical settings suggests that MR requires longitudinal reinforcement, repeated patient encounters and continued mentorship beyond a single workshop. This approach is feasible for broader implementation and may serve as a foundation for intentionally integrating MR across the medical education continuum.
(© 2026 The Author(s). The Clinical Teacher published by Association for the Study of Medical Education and John Wiley & Sons Ltd.)
References: Acad Med. 2020 Aug;95(8):1179-1185. (PMID: 32349018)
JAMA. 2018 Jun 12;319(22):2267-2268. (PMID: 29800012)
Acad Med. 2019 Sep;94(9):1310-1316. (PMID: 31460922)
Acad Med. 2023 Jan 1;98(1):80-87. (PMID: 35830267)
J Contin Educ Health Prof. 2012 Winter;32(1):4-9. (PMID: 22447706)
Med Sci Educ. 2024 Nov 15;35(1):459-467. (PMID: 40144125)
Diagnosis (Berl). 2022 Nov 23;10(1):19-23. (PMID: 36420532)
Diagnosis (Berl). 2023 Feb 20;10(3):218-224. (PMID: 36800998)
Diagnosis (Berl). 2022 Sep 08;9(4):476-484. (PMID: 36073963)
Acad Med. 2019 Jun;94(6):902-912. (PMID: 30720527)
Contributed Indexing: Keywords: clinical reasoning; curriculum development; management reasoning; medical education
Entry Date(s): Date Created: 20260615 Date Completed: 20260615 Latest Revision: 20260813
Update Code: 20260813
PubMed Central ID: PMC13268813
DOI: 10.1111/tct.70462
PMID: 42297562
Βάση Δεδομένων: MEDLINE
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  Data: Background: Management reasoning (MR), the component of clinical reasoning concerned with treatment planning, patient preferences and resource considerations, develops later than diagnostic reasoning and remains underemphasised in medical education. Despite calls to explicitly teach MR, instructional strategies remain scarce.&lt;br /&gt;Approach: We developed a mnemonic, the &quot;Six R&#39;s of Management Reasoning,&quot; and implemented a 90-min workshop grounded in social constructivism. Between July 2023 and December 2024, we taught 22 sessions to 119 subinterns. Students used the mnemonic to collaboratively construct management plans and admission orders through case-based activities and facilitated discussions.&lt;br /&gt;Evaluation: Using three levels of Kirkpatrick&#39;s model-reaction, learning and behaviour-we assessed the workshop through IRB-approved surveys, tests and workplace assessments. Postworkshop and postrotation surveys showed significant increases in students&#39; confidence and ability to apply MR (all p &amp;lt; 0.001). Knowledge test scores improved from 81.7% to 93.3% (p &amp;lt; 0.001, Hedges&#39;s g = 1.20). Faculty assessments confirmed students&#39; strengths in risk calculation and shared decision-making, though some students struggled with applying high-value care and citing evidence.&lt;br /&gt;Implications: The &quot;Six R&#39;s of Management Reasoning&quot; provided a practical tool for MR development, and activities selected based on social constructivism were effective and well received. Mixed performance in clinical settings suggests that MR requires longitudinal reinforcement, repeated patient encounters and continued mentorship beyond a single workshop. This approach is feasible for broader implementation and may serve as a foundation for intentionally integrating MR across the medical education continuum.&lt;br /&gt; (&#169; 2026 The Author(s). The Clinical Teacher published by Association for the Study of Medical Education and John Wiley &amp; Sons Ltd.)
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  Data: Acad Med. 2020 Aug;95(8):1179-1185. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2232349018%22&quot;&gt;32349018)&lt;/searchLink&gt;&lt;br /&gt;JAMA. 2018 Jun 12;319(22):2267-2268. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2229800012%22&quot;&gt;29800012)&lt;/searchLink&gt;&lt;br /&gt;Acad Med. 2019 Sep;94(9):1310-1316. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2231460922%22&quot;&gt;31460922)&lt;/searchLink&gt;&lt;br /&gt;Acad Med. 2023 Jan 1;98(1):80-87. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2235830267%22&quot;&gt;35830267)&lt;/searchLink&gt;&lt;br /&gt;J Contin Educ Health Prof. 2012 Winter;32(1):4-9. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2222447706%22&quot;&gt;22447706)&lt;/searchLink&gt;&lt;br /&gt;Med Sci Educ. 2024 Nov 15;35(1):459-467. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2240144125%22&quot;&gt;40144125)&lt;/searchLink&gt;&lt;br /&gt;Diagnosis (Berl). 2022 Nov 23;10(1):19-23. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2236420532%22&quot;&gt;36420532)&lt;/searchLink&gt;&lt;br /&gt;Diagnosis (Berl). 2023 Feb 20;10(3):218-224. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2236800998%22&quot;&gt;36800998)&lt;/searchLink&gt;&lt;br /&gt;Diagnosis (Berl). 2022 Sep 08;9(4):476-484. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2236073963%22&quot;&gt;36073963)&lt;/searchLink&gt;&lt;br /&gt;Acad Med. 2019 Jun;94(6):902-912. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2230720527%22&quot;&gt;30720527)&lt;/searchLink&gt;
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