A qualitative study of experienced clinical teachers’ conceptualisation of clinical reasoning in medicine: Implications for medical education
Keywords:Clinical reasoning, qualitative, teaching, medical education
Introduction: Clinical reasoning is an essential part of medical practice. Training medical students to reason competently is, therefore, an essential skill for clinical teachers. Ongoing debate over what clinical reasoning entails and difficulty explicitly teaching and assessing. it makes this a challenging task. This study explored clinical teachers’ understanding of the concept of clinical reasoning.
Methods: Nine experienced clinical teachers participated in semi-structured interviews about clinical reasoning, exploring concepts, experiences, teaching and assessment. Interviews were transcribed and analysed thematically.
Results: Ten key themes were identified in relation to participants’ understanding of clinical reasoning. These include the findings that clinical reasoning is: essential to medical practice, goal oriented, an applied cognitive process and an unconscious process. Clinical reasoning has several requirements, including knowledge, communication skills, experience and reflection. Participants reported that clinical reasoning is difficult, perhaps impossible, to teach.
Conclusions: In this qualitative study, clinical teachers concurred with many of the characteristics of clinical reasoning as it is understood in the literature, but they also challenged assumptions made in medical education research regarding the conceptualisation of clinical reasoning. This has implications for teaching, assessment, student selection and professional development.
Barrett, J., Yates, L., & McColl, G. (2015). Medical teachers conceptualise a distinctive form of clinical knowledge. Advances in Health Sciences Education, 20, 355–369.
Brailovsky, C., Charlin, B., Beausoleil, S., Coté, S., & van der Vleuten, C. (2001). Measurement of clinical reflective capacity early in training as a predictor of clinical reasoning performance at the end of residency: An experimental study on the script concordance test. Medical Education, 35, 430–436.
Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3, 77–101.
Braun, V., & Clarke, V. (2013). Successful qualitative research: A practical guide for beginners. London, England: Sage.
Dhaliwal, G. (2009). Teaching medicine to non-English speaking background learners in a foreign country. Journal of General Internal Medicine, 24, 771–773.
Durning, S. J., Artino, A. R., Boulet, J., Dorrance, K., van der Vleuten, C., & Schuwirth, L. (2012). The impact of selected contextual factors on experts’ clinical reasoning performance (does context impact clinical reasoning performance in experts?). Advances in Health Sciences Education, 17, 65–79.
Durning, S. J., Artino, A. R., Boulet, J., La Rochelle, J., van der Vleuten, C., Arze, B., & Schuwirth, L. (2012). The feasibility, reliability, and validity of a post-encounter form for evaluating clinical reasoning. Medical Teacher, 34, 30–37.
Durning, S. J., Artino, A. R., Schuwirth, L., & van der Vleuten, C. (2013). Clarifying assumptions to enhance our understanding and assessment of clinical reasoning. Academic Medicine, 88, 442–448.
Durning, S. J., Ratcliff, T., Artino, A. R., van der Vleuten, V. C., Beckman, T. J., Holmboe, . . . Schuwirth, L. (2013). How is clinical reasoning developed, maintained, and objectively assessed? Views from expert internists and internal medicine interns. Journal of Continuing Education in the Health Professions, 33, 215–223.
Epstein, R. M., & Hundert, E. M. (2002). Defining and assessing professional competence. Journal of the American Medical Association, 287, 226–235.
Eva, K. W. (2004). What every teacher needs to know about clinical reasoning. Medical Education, 39, 98–106.
Gay, S., Bartlett, M., & McKinley, R. (2013). Teaching clinical reasoning to medical students. Clinical Teacher, 10, 308–312.
Koenig, T., Parrish, S., Terregino, C., Williams, J., Dunleavy, D., & Volsch, J. (2013). Core personal competencies important for entering medical students’ success in medical school: What are they and how could they be assessed early in the admission process? Academic Medicine, 88, 603–613.
Kunina-Habenicht, O., Hautz, W. E., Knigge, M., Spies, C., & Ahlers, O. (2015). Assessing clinical reasoning (ASCLIRE): Instrument development and validation. Advances in Health Sciences Education, 20, 1205–1224.
Linn, A., Khaw, C., Kildea, H., & Tonkin, A. (2012). Clinical reasoning: A guide to improving teaching and practice. Australian Family Physician, 41, 18–20.
Lubarsky, S., Charlin, B., Cook, D. A., Chalk, C., & van der Vleuten, C. P. M. (2011). Script concordance testing: A review of published validity evidence. Medical Education, 45, 329–338.
Lubarsky, S., Dory, V., Duggan, P., Gagnon, R., & Charlin, B. (2013). Script concordance testing: From theory to practice: AMEE Guide No. 75. Medical Teacher, 35, 184–193.
Tracy, S. J. (2010). Qualitative quality: Eight “big-tent” criteria for excellent qualitative research. Qualitative Inquiry, 16, 837–851.
How to Cite
On acceptance for publication in FoHPE the copyright of the manuscript is signed over to ANZAHPE, the publisher of FoHPE.
Any reproduction of material published in FoHPE must have the express permission of the publisher.
Articles published in Focus on Health Professional Education (FoHPE) are available under Creative Commons Attribution Non-Commercial No Derivatives Licence (CC BY-NC-ND 4.0).