Clinical Reasoning: Talk the Talk or Just Walk the Walk?

Abstract

O nce the purview of the research community, clinical reasoning concepts are increasingly used to inform how teachers teach and learners learn. This welcome development has been signaled by the widespread use of clinical reasoning terminology in teaching sessions, conferences, and general medical publications. Technical terminology arises in any community where foundational units of knowledge (eg, terabyte or osmosis) are necessary for members to communicate with precision and brevity. For interdisciplinary fields like clinical reasoning, terminology evolves iteratively as multiple groups think about a problem independently, develop knowledge and language simultaneously, and then use these terms to communicate between groups. Given this evolutionary process, it is helpful to periodically examine the state of terminology and its utility to the members of a community. In this issue of the Journal of Graduate Medical Education, Musgrove et al compared the frequency of clinical reasoning terms in 79 published clinical problem solving exercises to a ranking of clinical reasoning concepts by a group of educators at a single academic center. They found that educators prioritized some of the same concepts that were featured prominently in published exercises (eg, problem representation, illness script, and dual process thinking), but that published exercises placed greater emphasis on such concepts as bias and context specificity. Given the different goals of clinical instruction and case reports, this discrepancy is not surprising. Teachers often frame their instruction around undifferentiated patients in ways that put reasoning front and center in order to stimulate the triggering and sorting of common diagnoses. In contrast, published cases prioritize the retrospective review of an engaging dilemma, often resolved by an unusual diagnosis. Clinical reasoning is at the core of the reader’s journey, but whether the case illustrates a specific clinical reasoning concept is often an afterthought. The analysis by Musgrove et al raises many interesting questions about these terms and their usage, but front line educators should consider this fundamental question: Is learning clinical reasoning lingo useful for teachers or their trainees?