The holistic approach to clinical problem using Fishbone format: A simple way for clinical reasoning

Introduction: clinical reasoning (CR) is thecornerstone of medical curricula. It is the cognitive process of solvingpatient’s problem. There are different teaching methods advocated to teachclinical reasoning, and each has its advantages and disadvantages.Aim: to introduce and discuss the fishboneformat as a systematic structured method to enhance teaching and learning of clinicalreasoning to medical students in different teaching settings.Method: The format consists of a head, sixbones and the tail. The head represents the presenting problem or complaint; thebones represent the different steps of the clinical reasoning. The first boneof defining the presenting problem is expanded to include the basic sciences. Inaddition we add a sixth rib for complication/prognosis and the tail is kept forthe prevention.Results: The format can be used in different teachingsettings such as, lecture theatre, small group discussion, tutorial, skills lab,and clinical settings. It will help both learner and preceptors to facilitate andguide teaching of clinical problem in a holistic logical sequence. Itencompasses both models of clinical reasoning, pattern of recognition and the hypothetico-deductiveone. Conclusion: This is a simple schemata aims to guidetrainers and students to see and learn the full picture of patient management andemphasize on integration rather than isolation of clinical competence domains duringteaching activities. Teachers and learners of other fields of science will findit helpful as well.