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Background <p>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.</p> Methods <p>A quasi-experimental study enrolled 82 first-year residents (2018–2021 cohorts) from a tertiary academic hospital. Participants in the experimental group (<i>n</i> = 45) voluntarily enrolled in a supplementary 56-hour course (organ-system modules, small-group case discussions), while the control group (<i>n</i> = 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.</p> Results <p>Baseline characteristics were comparable between groups (<i>p</i> &gt; 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, <i>p</i> &lt; 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 <i>p</i> &lt; 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.</p> Conclusion <p>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.</p>

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

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  • 发表日期：

    2026年2月2日

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  • Qin Zhou,
  • Xinxin Shao,
  • Xiaodan Wu,
  • Junying Guo,
  • Lu Yang,
  • Jianhong Ye,
  • Xia Feng,
  • Da-Ya Yang,
  • Qingchun Liang,
  • David C. M. Taylor

摘要

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.