Clinical Reasoning as a Core Competency

Abstract

Diagnostic error is a challenging problem; addressing it effectively will require innovation across multiple domains of health care, including medical education. Diagnostic errors often relate to problems with clinical reasoning, which involves the cognitive and relational steps up to and including establishing a diagnostic and therapeutic plan with a patient. However, despite a call from the National Academies of Sciences for medical educators to improve the teaching and assessment of clinical reasoning, the creation of explicit, theory-informed clinical reasoning curricula, faculty development resources, and assessment tools has proceeded slowly in both undergraduate and graduate medical education. To accelerate the development of this critical element of health professions education and to promote needed research and innovation in clinical reasoning education, the Accreditation Council for Graduate Medical Education (ACGME) should revise its core competencies to include clinical reasoning. The core competencies have proven to be an effective means of expanding educational innovation across the United States and ensuring buy-in across a diverse array of institutions and disciplines. Reformulating the ACGME core competencies to include clinical reasoning would spark much-needed educational innovation and scholarship in graduate medical education, as well as collaboration across institutions in this vital aspect of physicianship, and ultimately, could contribute to a reduction of patient suffering by better preparing trainees to build individual, team-based, and system-based tools to monitor for and avoid diagnostic error.

Morning report for all: a qualitative study of disseminating case conferences via podcasting

“…To help decrease diagnostic errors, the National Academies of Sciences issued a report that urged educators to improve clinical reasoning (CR) [2]. Additionally, there was a recent call to action for the ACGME (Accreditation Council for Graduate Medical Education) to include CR as a core competency [3]. However, despite its acknowledged importance, structured curricula for CR have suffered uneven implementation, with 57% of institutions in a national survey lacking such curricula [4].…”

A Cross-Sectional Study: What Contributes to Nursing Students’ Clinical Reasoning Competence?

“…More evidence is required to create a rigorous curriculum for nursing students, although nurse educators have been making an effort to include systematic clinical reasoning competence [ 9 , 10 ]. There is a lack of research on the factors associated with nursing students’ clinical reasoning competence.…”

“…The concept related to clinical reasoning has been emphasized in nursing education and practice [ 10 ]. Clinical reasoning, critical thinking, and clinical judgment are often used as a synonym in nursing studies.…”

Virtual Interactive Case-Based Education (VICE): A Conference for Deliberate Practice of Diagnostic Reasoning

“…2 In response to this problem, the National Academy of Sciences has called on medical educators to improve teaching and assessment of clinical reasoning. 3 Most current approaches to developing diagnostic reasoning skills focus on undergraduate medical learners, 4 and so, more effort is needed to develop dedicated programming that addresses this educational gap at the graduate medical education level, 1 particularly within internal medicine. 2 Prior work at the graduate medical education level includes longitudinal curricula on cognitive biases, clinical reasoning concepts, and diagnostic skills.…”

“…Diagnostic errors are a common source of avoidable patient harm and excess health care expenditures, 1 yet medical training fails to adequately develop trainees’ skills in diagnostic reasoning. 2 In response to this problem, the National Academy of Sciences has called on medical educators to improve teaching and assessment of clinical reasoning.…”