Clinical Reasoning Toolkit - For Educators
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Research in the field of clinical reasoning began in the 1970’s with the goal of helping trainees acquire this critical skill. Clinicians and psychologists have used research findings to guide day-to-day instruction and to develop curricula. It is very helpful for teachers to understand the "basic science” in the three previous sections when teaching clinical reasoning.

Quick Take: Read Judith Bowen’s article "Educational Strategies to Promote Clinical Diagnostic Reasoning”

Core resources (additional high-yield introductory information) are indicated by a STAR icon

Ready-to-use Resources: See Elizabeth Stuart’s exercises for teaching novice and struggling learners AND complete curricula (guides, handouts, and slides) under "Cognitive Errors Curricula”

 

Developing/Remedying Basic Differential Diagnosis Skills View

Elizabeth Stuart et al. Thinking about Thinking: Coaching Strategies to Promote Clinical Reasoning. COMSEP March 2011.

A collection of practical educational techniques for teaching clinical reasoning skills that can be used at the bedside and in the classroom.

Audetat MC, Beique C, Fon NC, Laurin S, Sanche G. Clinical Reasoning Difficulties: A guide to educational diagnosis and remediation.

A short but detailed (7 page) guide that includes cues and questions to detect common clinical reasoning problems and suggestions for remediation.

Cognitive Errors Curricula View

Penn Curriculum in Cognitive Bias and Diagnostic Error for Medical Residents
Brent Smith. Cognitive Debiasing Workshop for Medical Residents
Patrick Croskerry. Dalhousie University Critical Thinking Curriculum
Society of Hospital Medicine Hospital Quality & Patient Safety Online Academy.

An online learning module with post-test and accompanying answers, explanations, and references (payment required). Content is drawn from University of Pennsylvania Curriculum (above).

Teaching Clinical Reasoning View

Bowen JL. Educational strategies to promote clinical diagnostic reasoning. New England Journal of Medicine. 2006.

This paper deconstructs the clinical reasoning process into several discrete steps and suggests teaching strategies for improving learner performance at each step.

Fleming A, Cutrer W, Reimschiesel T, Gigante J. You too can teach clinical reasoning! Pediatrics. 2012.

Useful suggestions on how to use learner oral presentations and written notes to analyze and improve the clinical reasoning skills of medical students.

Audetat MC, Laurin S. Supervision of clinical reasoning: methods and a tool to support and promote clinical reasoning. Canadian Family Physician. 2010.

A brief review that outlines the clinical reasoning process and details specific methods a clinical teacher can use to help a learner struggling with any of the steps. [FREE PubMed Article]

Eva KW. What every teacher needs to know about clinical reasoning. Medical Education. 2005.

An introduction for clinical teachers on outlining intuitive and analytical reasoning and how to access and encourage learners’ use of both processes.

Mark Quirk. Shifting the Medical Education Paradigm from Knowledge to Critical Thinking.

A detailed look at the need to focus on promoting critical thinking skills in medical education with a specific emphasis on developing the metacognitive skills of learners.

Gurpreet Dhaliwal. Improving Diagnostic Reasoning.

This 9 minute narrated slide presentation details a straightforward method for individual clinicians to improve their diagnostic performance based on educational and expertise principles.

Teaching Clinical Reasoning Bibliography

Teaching about Diagnostic Errors View

Graber ML. Educational strategies to reduce diagnostic error: can you teach this stuff? Advances in Health Sciences Education. 2009.

A review paper that details the different ways educators can teach about diagnostic error; emphasizes the role of reflection in improving performance.

Trowbridge RL. Twelve tips for teaching avoidance of diagnostic errors. Medical Teacher. 2008.

A compilation of techniques to introduce learners to methods of decreasing diagnostic error.

Eva KW. Diagnostic error in medical education: where wrongs can make rights. Advances in Health Sciences Education. 2009.

This review presents a persuasive educational case for allowing learners to safely make diagnostic mistakes as a means of improving their diagnostic performance.

Learning From Feedback View

Schiff GD. Minimizing diagnostic error: the importance of follow-up and feedback. American Journal of Medicine. 2008.

A detailed discussion of the importance of feedback in calibrating diagnostic performance, the barriers to accessing this feedback and the complexity inherent in the process.

Croskerry P. The feedback sanction. Academic Emergency Medicine. 2000.

A review that argues that clinicians must receive feedback on their diagnostic performance, which occurs infrequently in the current medical environment.

Teaching through Cases View

Kassirer JP. Teaching clinical reasoning: case-based and coached. Academic Medicine. 2010.

An argument that learning clinical reasoning must both be based on real clinical cases (in person or simulated) and be guided by an experienced teacher or coach.

AHRQ PS NET Diagnostic Error Cases

AHRQ Web M&M Diagnostic Error Cases

Learn More about Diagnostic Errors View