A CASE-BASED NEPHROLOGY CONSULTATION CURRICULUM TO ENHANCE INTERDISCIPLINARY CLINICAL REASONING AMONG RESIDENTS

In modern clinical settings, interdisciplinary clinical reasoning skills and associated education are pivotal and should be encouraged for residency training. During their university education, students develop an initial framework for clinical reasoning through the study of Diagnostics. However, in postgraduate education, the cultivation of clinical reasoning skills mainly relies on specialty-specific clinical mentoring. The quality of such training varies considerably across specialties and instructors, and there are no standardized textbooks or established models for interdisciplinary clinical reasoning teaching. The gap between the urgent need for interdisciplinary reasoning skills in clinical practice and the lack of corresponding curricular systems represents a major challenge in developing courses aimed at enhancing interdisciplinary clinical reasoning. Clinical reasoning in nephrology covers a broad range of topics and requires a strong foundation in pathophysiology. Designing such courses therefore places higher demands on instructors. In response, we initiated an exploratory curriculum reform — starting from the underlying pathophysiological mechanisms and integrating real clinical consultation scenarios — to enhance residents’ interdisciplinary clinical reasoning skills. 

Based on the Four-Component Instructional Design (4C/ID) Model proposed by renowned educational design expert Professor Jeroen van Merriënboer from Maastricht University (The Netherlands), we developed the “Into the Kidney” course plan. Following the ten steps across the four components of this comprehensive learning design framework, we structured the course around 1) “Learning tasks” — solving real consultation cases; 2) “Supportive information” — interactive, instructor-guided discussions; 3) “Procedural information” — targeted practice embedded before, during, and after each case discussion; 4) “Part-task practice” — focused exercises to strengthen specific reasoning skills.

We curated and designed ten common nephrology consultation scenarios, each linked to a core pathophysiological concept in nephrology (Table 1). Each scenario begins with a consultation case that raises a clinical question, which then leads to the exploration of the underlying pathophysiological mechanisms. The discussion develops around the case and concludes with a synthesis of clinical reasoning and a structured diagnostic and therapeutic approach. This instructional design progresses from surface to depth, from theory to practice—solidifying pathophysiological foundations while simultaneously enhancing interdisciplinary clinical reasoning skills. Each session brings together instructors from multiple disciplines for joint discussion.

Table 1. Consultation case-based learning design

Since November 2023, the interdisciplinary curriculum has been offered in two rounds, each consisting of ten weekly sessions. The enrollment for both rounds has attracted significant interest, with 25% of participants in the second round having attended the first round. Participants came from 18 different specialties, including general internal medicine, general surgery, traditional Chinese medicine, medical imaging, laboratory medicine, and nursing. According to participation surveys, a total of 140 learners were admitted across the two rounds, with nephrology trainees accounting for less than 50% of the participants. Over 90% participants were satisfied with our course and over 79.2% participants achieved improved interdisciplinary skills. Furthermore, 80% participants reported behavior changes in professional clinical practice after the completion of the course. 

This study developed an interdisciplinary course grounded in real clinical consultation cases, which enhanced residents’ clinical reasoning, analytical, and problem-solving skills in complex clinical settings, while also fostering communication and collaboration among different disciplines.