Assessing and remediating clinical reasoning

Trainees must have excellent clinical reasoning skills to practice medicine safely and effectively. Even when a trainee has an impressive knowledge base, he or she can have difficulty applying that knowledge to patient problems. In this chapter, the authors discuss how the cognitive processes involved in decision-making apply in medicine. They propose a framework for how educators can teach and model decision-making to medical trainees based on the literature and their extensive experience with novice clinicians. They propose that learners should manifest progress of clinical reasoning in four ways: (1) an improved ability to develop and share a concise verbal or written problem representation; (2) an increasing and consistent use of semantic qualifiers; (3) the ability to state, seek, identify, and recall the defining and discriminating features of a patient's history and physical exam and link this to their knowledge base of "illness scripts" and (4) demonstrate an increasing metacognitive awareness which reduces cognitive biases in patient evaluations. They provide detailed descriptions of an array of strategies to address immature clinical reasoning.