The Teaching of Clinical Reasoning by Senior Clinicians

Abstract

Background. At our medical school, the teaching of clinical reasoning starts in a well-structured curriculum in the pre-clinical years. In the clinical years, however, teaching is less structured and delivered by multiple teachers. The aim of our study was to understand how senior clinicians teach clinical reasoning. Summary of work. Because there are no validated questionnaires to assess how clinical reasoning is taught, we conducted individual interviews with 14 senior clinicians to establish how they defined clinical reasoning, how they were teaching it, how they themselves had been taught, and what changes should be made to their teaching. Summary of results Senior clinicians teach clinical reasoning opportunistically. They emphasised the importance of supervised practice, reflection, think aloud, focused data collection guided by the clinical presentation, and the iterative nature of reasoning. They identified teaching as a way to further develop their own reasoning. Few recall being formally taught clinical reasoning. Discussion Our findings challenge the notion that teachers teach the way they were taught. Though most participants reported that they had not been explicitly taught clinical reasoning they were dedicated to teaching it to their own students. Despite their informal definitions, they suggested teaching clinical reasoning in a systematic way. Conclusion Overwhelmingly, senior clinicians want to enhance and structure how clinical reasoning is taught in the clinical years. The teaching experiences of senior clinicians appear to be an important resource when revising the curriculum and planning for faculty development about the teaching of clinical reasoning. Take home messages Senior clinicians use an apprenticeship model of workplace learning to teach clinical reasoning. This model provides them with opportunities to teach clinical reasoning to their students in a variety of clinical contexts and enables them to make this tacit thinking process as explicit as possible to their students.