Sadia Chaudhry, Rehan Ahmed Khan, Rahila Yasmeen
Cognitive processes that activate clinical reasoning are complicated. These cognitive processes are either analytical (slow) or non-analytical (fast). This research focuses on how thinking cultivates and alters over the course of years spent in medical college and how they are different in high vs borderline medical students. Objective: The study aims to explore the cognitive schemes, build up by medical students with different achievement records for clinical diagnostic reasoning, the pathways followed by them for diagnostic reasoning and to explore neurocognitive factors that influence their clinical diagnostic reasoning. Methodology: The sampling technique was purposively followed by theoretical sampling. The study was conducted from Dec 2016 to May 2017. This was a qualitative study based on the Grounded theory of Constructivist design. In-depth interviews were audio-recorded, transcribed, and analyzed manually. Results: Using thematic analysis, 8 themes surfaced. Students of high achievement followed pattern recognition (system 1). Hypothetical deductive reasoning (system 2) was followed by borderline students. However, most strategies of reasoning were uniformly distributed among high achievers and borderline students. Sleep deprivation and fatigue were the two most important factors which affected the cognitive schemes of medical students. Conclusion: Clinical reasoning in medical education is of significance in the development of future doctors. The actual reasoning process includes medical decision-making on one hand and problem-solving on the other hand. Cognitive schemes of high achiever students are based on pattern recognition and borderline students follow hypothetical deductive reasoning. Keywords: Cognitive schemes, clinical diagnostic reasoning, system 1, system 2, pattern recognition, hypothetico-deductive reasoning.