Consensus statement on the content of clinical reasoning curricula in undergraduate medical education

Figures & data

Table 1. Knowledge, skills and behaviours in the different domains of clinical reasoning.

Domain	Areas of knowledge, skills and behaviours
Clinical reasoning concepts	Demonstrate an understanding of: Clinical reasoning theories (e.g. script, dual process) How clinical reasoning ability develops The role of clinical reasoning in safe and effective care for patients Cognitive errors Other factors that may impair the clinical reasoning process/outcome
History and physical examination	Demonstrate the ability to use: Effective communication skills and purposeful interviewing History taking from all available sources when relevant Hypothesis-driven enquiry Knowledge of epidemiology, probability of the presence of signs and symptoms in specific diseases, and likelihood ratios to estimate clinical probability
Choosing and interpreting diagnostic tests	Demonstrate a practical understanding of and ability to use the following: Pre-test (clinical) probability and post-test probability Sensitivity and specificity Predictive values Factors other than disease that influence test results Important characteristics of commonly used tests relevant to local context Evidence-based guidelines
Problem identification and management	Demonstrate an ability to produce: An accurate problem representation or problem list Use of semantic qualifiers and precise medical terms Prioritised differential diagnosis, including relevant ‘must not miss’ diagnoses Safe actions when a diagnosis is not possible Management plans taking patient’s preferences, co-morbidities, resources, cost-effectiveness and local policies in to account Metacognition and critical thinking in decision making
Shared decision making	Demonstrate the ability to make decisions with: Patients and carers Clinical teams Guidelines, scores and decision aids Evidence-based medicine applied to the patient’s circumstances Professional values and behaviours that support decision making

Table 2. Effective teaching strategies.

Strategy	Examples
Strategies that build understanding	Self-explanation (getting learners to make connections and elaborate by explaining their thinking and rationale) Explaining the basic science mechanisms for symptoms and signs
Strategies that employ structured reflection	Encouraging students to ask themselves questions like, ‘What’s the evidence for this? What else could it be?’ Asking students to list findings compatible or not compatible with each differential diagnosis
Practice with cases and corrective feedback	Providing opportunities to practice with as many different cases as possible in as many different contexts as possible Using a whole case approach for novices to reduce cognitive load (have all the information they need to solve the problem readily available throughout) Ensuring coaching and feedback on the clinical reasoning process
Strategies that structure knowledge around problem-specific concepts	Learning a diagnostic ‘decision tree’ in later years of medical school once fundamental concepts have been learned, underpinned by relevant basic science, clinical knowledge and evidence
Strategies that employ retrieval practice	Activities that promote effortful recall of information during teaching activities rather than the teacher explaining information Use of structured reflection while solving cases Spaced practice (studying topics in shorter, spaced apart blocks rather than a single block and moving on) Contrastive learning (getting learners to list features they would expect in one diagnosis compared with another)
Strategies that differ according to stage of learning	Low complexity, low fidelity tasks with high instructional support in the early years moving to high complexity, high fidelity tasks with minimal instructional support by final year at medical school Approaching graduation, opportunity to work as part of a clinical team in a real supervised environment