The terminology of clinical reasoning in health professions education: Implications and considerations

Abstract

Introduction: Clinical reasoning is considered to be at the core of health practice. Here, we report on the diversity and inferred meanings of the terms used to refer to clinical reasoning, and consider implications for teaching and assessment. Methods: In the context of a Best Evidence Medical Education (BEME) review of 625 papers drawn from 18 health professions, we identified 110 terms for clinical reasoning. We focus on iterative categorization of these terms across three phases of coding and considerations for how terminology influences educational practices. Results: Following iterative coding with 5 team members, consensus was possible for 74, majority coding was possible for 16, and full team disagreement existed for 20 terms. Categories of terms included: purpose/goal of reasoning, outcome of reasoning, reasoning performance, reasoning processes, reasoning skills, and context of reasoning. Discussion: Findings suggest that terms used in reference to clinical reasoning are nonsynonymous, not uniformly understood, and the level of agreement differed across terms. If the language we use to describe, to teach, or to assess clinical reasoning is not similarly understood across clinical teachers, program directors, and learners, this could lead to confusion regarding what the educational or assessment targets are for 'clinical reasoning'.

Clinical reasoning performance assessment: using situated cognition theory as a conceptual framework

“…This definition adds some of the contextual factors excluded from the model for simplicity to show how complex the assessment of clinical reasoning performance can be. In conformity with Young et al's findings [12], this phrase should not be viewed as a "one size fits all" definition, but one which can be used by researchers and educators using a situated cognition lens to clarify their perspective. A situated cognition perspective leads to a different assessment focus as compared to the more traditional information processing view (e.g.…”

“…The construct of clinical reasoning is multi-faceted and complex. A recent review of the health professions education literature demonstrated this fact by identifying 110 different words used for clinical reasoning [12]. Constructs of clinical reasoning vary across as well as within health professions because of variations in scope of practice (ME Young, oral communication).…”

Mapping clinical reasoning literature across the health professions: a scoping review

“…Terms for which the team could not agree were not included in the analyses reported in this manuscript. This categorization process is described in more detail elsewhere (Young et al 2019) [29], including the terms for which consensus was not possible.…”

What Is Lost in Postgraduate Residency During COVID-19 Times?—a Resident Perspective on Diagnostic Error

“…In addition to the uncertainty regarding the time of resumption of routine clinics, tremendous loss in psychomotor skills training, and fatigable hours of posting in critical units, the cardinal loss incurred is the blunt of clinical reasoning skills, which forms the crux of evidence-based medicine. Apart from the internal determinants such as motivation, cognitive quest, and burnout, the process of clinical reasoning can also be influenced by external influencers such as time constraints, environmental cues, and lack of investigations [2]. The pandemic outbreak has posed as an additional extrinsic constraint to the process of diagnostic reasoning owing to the fact that physical examination is done with 'social distancing' protocols with more emphasis being levied upon 'unwarranted' investigations.…”