Does online case-based learning foster clinical reasoning skills? A mixed-methods study.

Background: Blended learning, integrating face-to-face and virtual methods, has become essential in clinical education, enhancing student satisfaction, engagement and knowledge outcomes. Particularly, online case-based learning emerges as a promising pedagogy to foster clinical reasoning skills. Despite the well-documented clinical reasoning cultivation through face-to-face case-based learning, the ability of online case-based learning to cultivate clinical reasoning remains unexplored. This study investigates the role of online case-based learning in fostering clinical reasoning skills among clinical-year medical students. Methods: A mixed-methods sequential explanatory research study was adopted. In the first phase, quantitative data were gathered through a 16-item Likert scale questionnaire adapted from validated clinical reasoning questionnaires. In the second phase, focus group discussions were conducted to expand on the understanding of quantitative results. Results: In total, 160 students completed the questionnaire (45% response rate), and 26 participated in focus group discussions. Participants agreed that online case-based learning fostered clinical reasoning skills (mean = 2.94) through different formats, such as clinical role play, simulated ward rounds and virtual consultation. Compared to face-to-face clinical teaching, the focus group revealed that participants were allowed to practise giving explanations to patients, engage in more in-depth discussions, and receive more comprehensive feedback on their clinical reasoning skills during online case-based learning. The barriers to online clinical reasoning skills development were poorer communication skills development and reduced student engagement. The lack of patient complexities of cases and the inability to perform physical examinations hindered students' clinical reasoning ability. Suggestions to improve clinical reasoning cultivation include utilising actual patient cases, increasing case complexity and session interactivity. Conclusion: This study highlights how online case-based learning can support the development of clinical reasoning skills in medical students, encouraging future educators to adopt a blended learning approach. Future research should focus on objective assessments, long-term impacts and innovative methods to improve clinical reasoning skill development continuously.