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 non-synonymous, 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.”

Acknowledgments

The authors would like to thank members of the BEME collaboration for their support. We would like to acknowledge those who participated in screening the articles included in our review, who were not part of the definitional review: Michelle Daniel, Carlos Estrada, Anita Hart, Brian Heist, Valerie Lang, Katherine Picho, Patrick Rendon, Sally Santen, and Dario Torre. We also would like to acknowledge the work of the academic librarians, Nancy Allee, Donna Berryman, and Elizabeth Richardson, who aided in developing the original search strategy.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article. The views expressed herein are those of the authors and not necessarily those of the Department of Defense or other federal agencies.

Additional information

Funding

This work was partially supported by funds provided by the Department of Medicine, McGill University, and by the Fonds de recherche du Quebec – Sante to M. Young.

Notes on contributors

Meredith Young

Meredith Young, PhD, is an associate professor, Department of Medicine, and research scientist, Center for Medical Education, Faculty of Medicine, McGill University, Montreal, Quebec, Canada.

Aliki Thomas

Aliki Thomas, PhD, OT (c), erg., is an associate professor, School of Physical and Occupational Therapy, and research scientist, Center for Medical Education, Faculty of Medicine, McGill University; and researcher, Center for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, Quebec, Canada.

David Gordon

David Gordon, MD, is an associate professor, Division of Emergency Medicine, Department of Surgery, Duke University School of Medicine, Durham, North Carolina.

Larry Gruppen

Larry D. Gruppen, PhD, is a professor, Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Michigan, USA. ORCID id: 0000-0002-2107-0126

Stuart Lubarsky

Stuart Lubarksy, MD MHPE, is an assistant professor, Department of Neurology, and core member, Center for Medical Education, Faculty of Medicine, McGill University, Montreal, Quebec, Canada.

Joseph Rencic

Joseph Rencic, MD, is an associate professor of medicine, Tufts University School of Medicine, and member, Division of General Internal Medicine, Tufts Medical Center, Boston, Massachusetts, USA.

Tiffany Ballard

Tiffany Ballard, MD, is a plastic surgery resident, University of Michigan, Ann Arbor, Michigan, USA.

Eric Holmboe

Eric Holmboe, MD, is a senior vice president for milestone evaluation and development, Accreditation Council for Graduate Medical Education, Chicago, Illinois, and adjunct professor of medicine, Yale University, New Haven, Connecticut, and Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.

Ana Da Silva

Ana Da Silva, PhD, is a lecturer at Swansea University, Swansea, Wales, UK

Temple Ratcliffe

Temple Ratcliffe, MD, is an associate professor, Department of Medicine, University of Texas Health Science Center, San Antonio, Texas, USA.

Lambert Schuwirth

Lambert Schuwirth, MD PhD, is a professor of medical education, Flinders University, and director, Flinders University Prideaux Center for Research in Health Professions Education, Adelaide, South Australia; and professor of medical education, Maastricht University, Maastricht, the Netherlands; Chang Gung University, Taoyuan City, Taiwan, China; and Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.

Steven J. Durning

Steven J. Durning, MD PhD, is a professor of medicine and director of graduate programs in health professions education, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.