title: Factors associated with medical student clinical reasoning and evidence based medicine practice.
abstract: OBJECTIVE
  To identify the factors associated with medical students' clinical reasoning (CR) use and evidence-based medicine (EBM) use in the clinical setting.
  
  
  METHODS
  Our cross-sectional study surveyed 44 final-year medical students at an emerging academic medical center in Singapore. We queried the students' EBM and CR value and experiences in the classroom and clinical settings. We compared this to their perceptions of supervisors' value and experiences using t-tests. We developed measures of teaching culture and practice culture by combining relevant questions into summary scores. Multivariate linear regression models were applied to identify factors associated with the students' CR and EBM clinical use.
  
  
  RESULTS
  Eighty-nine percent of students responded (n=39). Students reported valuing CR (p=0.03) and EBM (p=0.001) more than their supervisors, but practiced these skills similarly (p=0.83; p=0.82). Clinical practice culture and classroom CR experience were independently associated with students' CR clinical use (p=0.05; p=0.04), and classroom EBM experience was independently associated with students' EBM clinical use (p=0.03). Clinical teaching culture was not associated with students' CR and EBM clinical use.
  
  
  CONCLUSIONS
  Our study found that medical students' classroom experience and the clinical practice culture influenced their CR and EBM use. The clinical teaching culture did not. These findings suggest that in order to increase student CR and EBM use, in addition to providing classroom experience, medical educators may need to change the hospital culture by encouraging supervisors to use these skills in their clinical practice.
authors.affiliation: Duke-NUS (National University of Singapore) Graduate Medical School,Singapore.
authors.forename: Arpana R
authors.initials: AR
authors.lastname: Vidyarthi
authors.affiliation: Duke-NUS (National University of Singapore) Graduate Medical School,Singapore.
authors.forename: Robert
authors.initials: R
authors.lastname: Kamei
authors.affiliation: Duke-NUS (National University of Singapore) Graduate Medical School,Singapore.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Chan
authors.affiliation: Duke-NUS (National University of Singapore) Graduate Medical School,Singapore.
authors.forename: Sok-Hong
authors.initials: SH
authors.lastname: Goh
authors.affiliation: Duke-NUS (National University of Singapore) Graduate Medical School,Singapore.
authors.forename: Ngee
authors.initials: N
authors.lastname: Lek
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D004501:Education, Medical / Q000379:methods*; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D008297:Male; D013337:Students, Medical / Q000523:psychology*; D011795:Surveys and Questionnaires; D013850:Thinking; D055815:Young Adult
keywords: Medical student education; clinical culture; clinical reasoning; curriculum development; evidence based medicine