Work

Impact of a tripartite framework on perioperative clinical reasoning in junior anaesthesiology residents in China: a longitudinal quasi-experimental study

Year: 2026

Type: article

Abstract: BACKGROUND: Perioperative clinical reasoning is a pivotal competency in anaesthesiology, yet it remains underdeveloped in many residency curricula, including in China. We implemented a longitudinal elective course based on script and dual-process theories, featuring a "tripartite framework" (integrating patient-, surgery-, and anaesthetic-related factors) to enhance reasoning skills among junior residents. METHODS: A quasi-experimental study enrolled 82 first-year residents (2018-2021 cohorts) from a tertiary academic hospital. Participants in the experimental group (n = 45) voluntarily enrolled in a supplementary 56-hour course (organ-system modules, small-group case discussions), while the control group (n = 37) received conventional training. Facilitators (≥ 15 years' clinical experience, AMEE-certified) guided script development, analytical reasoning, and application of a tripartite framework (patient-, surgery-, and anaesthetic factors). A blended assessment strategy-incorporating MCQs, structured oral examinations, and anaesthesia planning tasks-was employed at 3-4 months and approximately 16 months post-intervention to evaluate short-term pedagogical impact and medium-term competency development. Questionnaires were distributed to evaluate course satisfaction and perceived clinical utility. Effect sizes (Cohen's d) were calculated to assess educational impact. RESULTS: Baseline characteristics were comparable between groups (p > 0.05). In the short-term assessment (3-4 months), the experimental group outperformed controls only in anaesthesia planning (64.2 ± 5.8 vs. 60.8 ± 8.5, p < 0.05, d = 0.47). Notably, by the 16-month medium-term assessment, the experimental group demonstrated significant and comprehensive superiority in all domains: MCQs (108.9 ± 8.8 vs. 99.8 ± 8.9, d = 1.02), anaesthesia planning (78.7 ± 9.1 vs. 70.5 ± 8.2, d = 0.94), and oral exams (80.5 ± 10.7 vs. 67.7 ± 9.1, d = 0.99) (all p < 0.01). While 47.7% of participants reported a notable learning burden, 95.5% expressed overall satisfaction and 97.7% perceived a positive impact on clinical practice. CONCLUSION: This course effectively bridges cognitive theory and clinical practice, demonstrating measurable improvements in perioperative reasoning. The tripartite framework provides a replicable cognitive scaffold for high-acuity specialty training. Longitudinal data underscore the importance of sustained practice and blended assessments for competency maturation.

Source: BMC Medical Education

DOI: 10.1186/s12909-026-08706-w