Five decades of research and theorization on clinical reasoning: a critical review

Figures & data

Table 1 Scientific studies about clinical reasoning that has been title and abstract reviewed

First decade	Second decade	Third decade	Fourth decade	Fifth decade
Feinstein (1974)^Citation41 Rubin (1975)^Citation42 Elstein et al (1978)^Citation43 Elstein & Bordage (1979)^Citation44	Kraytman et al (1981)^Citation45 Feltovich et.al (1984)^Citation46 Kuipers & Kassirer (1984)^Citation47 Schmidt & de Volder (1984)^Citation23 McGuire (1985)^Citation48 Patel et al (1986)^Citation19 Barrows et al (1987)^Citation31 Case et al (1988)^Citation32 Hamm (1988)^Citation39 Groen & Patel et al (1988)^Citation49 Girotto & Legrenzi (1989)^Citation50	Elstein et al (1990)^Citation18 Joseph & Patel (1990)^Citation51 Patel et al (1990)^Citation52 Norman et al (1990)^Citation53 Schmidt et al (1990)^Citation25 Ericsson (1991)^Citation54 Kaufman (1991)^Citation55 Mattingly (1991)^Citation56 Custers et al (1992)^Citation57 Evans & Patel (1992)^Citation58 Florance (1992)^Citation59 Henny Boshuizen et al (1992)^Citation60 Higgs (1992)^Citation20 Arocha et al (1993)^Citation61 Hassebrock et al (1993)^Citation62 Patel et al (1993)^Citation63 Schmidt et al (1993)^Citation64 Higgs (1993)^Citation65 Joseph Arocha et al (1993)^Citation66 Bordage (1994)^Citation67 Elstein (1994)^Citation22 Patel et al (1994)^Citation68 Jones (1995)^Citation69 Joseph Arocha & Patel (1995)^Citation70 Custers (1995)^Citation71 Custers et al (1996)^Citation26,Citation28 Hammond (1996)^Citation38 Mandin et al (1997)^Citation30 Van de Wiel (1997)^Citation72 Allen et al (1998)^Citation73 Chang & Bordage (1998)^Citation74 Charlin et al (1998)^Citation75 Custers et al (1998)^Citation24 Cuthbert (1999)^Citation76 Kaufman et al (1999)^Citation77 Round (1999)^Citation78	Charlin et al (2000)^Citation12 Carter & Robinson (2001)^Citation79 Harries & Harries (2001)^Citation80 Round (2001)^Citation6 Elstein & Schwarz (2002)^Citation81 Nendaz (2002)^Citation82 Patel et al (2002)^Citation83 Bleakley et al (2003)^Citation84 Coderre et al (2003)^Citation85 Norman & Eva (2003)^Citation86 Eshach & Bitterman (2003)^Citation87 Groves et al (2003)^Citation88 Hardin (2003)^Citation89 Charlin &Van der Vleuten (2004)^Citation90 Eva (2004)^Citation91 Rikers et al (2004)^Citation92 Verkoeijen et.al (2004)^Citation93 Holyoak & Morrison (2005)^Citation21 Norman (2005)^Citation3 Tamayo-Sarver (2005)^Citation94 Anderson (2006)^Citation95 Bowen (2006)^Citation96 Eva & Cunnington (2006)^Citation97 Loftus (2006)^Citation5 Montgomery (2006)^Citation98 Novak et al (2006)^Citation99 Thornton (2006)^Citation100 Auclair (2007)^Citation101 Schmidt & Rikers (2007)^Citation102 Norman et al (2007)^Citation11 Banning(2008)^Citation103 Evans (2008)^Citation13 Harasym et al (2008)^Citation29 Heiberg (2008)^Citation104 Higgs (2008)^Citation7 Humbert (2008)^Citation105	Aleluia et al (2010)^Citation113 Corcoran (2010)^Citation114 Mariasin (2010)^Citation115 Lee et al (2010)^Citation116 Omana et al (2010)^Citation117 Wilhelmsson (2010)^Citation118 Thomson et al(2010)^Citation8 Amini et al (2011)^Citation119 Durning (2011)^Citation120 Franklin et.al.(2011)^Citation121 Pelaccia et al (2011)^Citation1 Thomson et al (2011)^Citation8 Adams (2012)^Citation122 Ashoorion et al (2012)^Citation123 Van Bruggen (2012)^Citation124 Charlin et al (2012)^Citation125 Demirören & Palaoğlu (2012)^Citation126 Braude (2012)^Citation127 Braude (2012)^Citation128 Khatami et al (2012)^Citation129 Lucchiari & Pravettoni (2012)^Citation10 Loftus (2012)^Citation4 Marcum (2012)^Citation34 Nouh et al (2012)^Citation130 Shaban (2012)^Citation131 Adams (2013)^Citation9 Custers (2013)^Citation40 Audétat et al (2013)^Citation132 Da Silva (2013)^Citation133 Evans & Stanovich (2013)^Citation36 Gigante (2013)^Citation134 Kriewaldt (2013)^Citation135 Lubarsky et al (2013)^Citation136 Munshi et al (2013)^Citation137 Smith (2013)^Citation138 Weiss et al (2013)^Citation139 Ilgen et al (2013)^Citation140
			Noreen et al (2008)^Citation106 Vertue & Haig (2008)^Citation107 Braude(2009)^Citation108 Bissessur et al (2009)^Citation109 Carrière et al (2009)^Citation110 Croskerry (2009)^Citation35,Citation37 Elstein (2009)^Citation33 Stempsey (2009)^Citation15 Rehder & Woo Kim (2009)^Citation111 Vosniadou (2009)^Citation112	Bowen & Ilgen (2014)^Citation141 Delany & Golding (2014)^Citation142 Freiwald et al (2014)^Citation143 Geisler et al (2014)^Citation144 Gordon (2014)^Citation145 Holmboe & Durning (2014)^Citation146 Hrynchak et al (2014)^Citation147 Hochberg et al (2014)^Citation148,Citation149 Monajemi (2014)^Citation150 Roots (2014)^Citation151 Salkeld (2014)^Citation152 Smith et al (2014)^Citation153 Capaldi (2015)^Citation154 Custers (2015)^Citation27 Gaba (2015)^Citation155 Islam et al (2015)^Citation156 Lafleur & Leppink (2015)^Citation157 Lubarsky et al (2015)^Citation158 Park et al (2015)^Citation159 Lisk (2016)^Citation160 McBee et al (2016)^Citation161 Gruppen (2017)^Citation162 Haring et al (2017)^Citation14 Jarodzka et al (2017)^Citation163 Norman et.al (2017)^Citation164 Ten Cate et.al (2017)^Citation165 Zamani et al (2017)^Citation166 Bowen & ten Cate (2018)^Citation167 Custers (2018)^Citation168 Daly (2018)^Citation2 King et al (2018)^Citation169 Keemink et al (2018)^Citation170 Lopes et al (2018)^Citation171 Yazdani & Hoseini (2017)^Citation172 Yazdani et al (2018)^Citation173 Higgs et al (2018)^Citation174

Figure 1 PRISMA flowchart.

Table 2 The list of 31 related literatures that included in the review

Category no.	Theory/model	Author	Year	Aspects related to supporting/criticizing the model
First category: theories and models based on the process of clinical reasoning	Hypothetico-deductive model	Elstein	1990^Citation18	The description of the hypothetico-deductive model The advantages of hypothetico-deductive model
		Patel	1986^Citation19	Lack of consistency of hypothetico-deductive model with other domains
		Higgs	1992^Citation20	Clinical reasoning process is not sequential
		Charlin	2000^Citation12	Unfamiliarity of psychological mechanisms involved in this model
		Holyoak	2005^Citation21	No differentiation between novice and expert clinical reasoning
		Loftus	2006^Citation5	Clarification of the role of hypothesis in clinical reasoning process
		Higgs	2008^Citation7	Adequate description of the process of clinical reasoning
		Elstein	1994^Citation22	Application of hypotheses for framing of clinical problems
Second category: theories and models based on the knowledge structure	Illness script theory	Schmidt	1984^Citation23	The description of the illness script theory Formation and development of the illness script
		Custers	1998^Citation24	The description of the illness script theory
		Schmidt	1990^Citation25	The structure of illness script Formation and development of the illness script
		Custers	1996^Citation26	The structure of illness script
		Custers	2015^Citation27	Script concordance test Formation and development of the illness script
		Custers	1996^Citation28	The structure of illness script
		Harasym	2008^Citation29	Formation and development of the illness script
		Mandin	1997^Citation30	Distinction between the concept of the script and the schema
	Pattern recognition model	Barrows	1987^Citation31	The description of the model
		Case S	1987^Citation32	It used by experienced practitioners
		Norman	2007^Citation11	The most usual form of nonanalytic processes
		Elstein	2009^Citation33	Unanswered questions about pattern recognition model
		Marcum	2012^Citation34	The complexity of cognitive processes involved in clinical reasoning to be ignored.
		Higgs	2008^Citation7	Pattern recognition model examined in limited field of expertise.
Third category: compilation theories and mode	Dual processing theory	Evans	2008^Citation36	The description of the theory
		Croskerry	2009^Citation35	Advantages of this theory
		Croskerry	2009^Citation37	Proposing a model based on dual processing theory
		Pelaccia	2011^Citation1	Clarification of the place of pattern recognition and hypothetico-deductive models in dual processing theory.
		Evans	2013^Citation36	Criticized this theory in five major themes
		Lucchiari	2012^Citation10	Models based on dual processing theory
	Cognitive continuum	Hammond	1996^Citation38	The description of the theory
		Hamm	1988^Citation39	The description of the theory
		Custers	2013^Citation40	Advantages of this theory

Table 3 The studies that deal with the concept of “script,” “schema,” and “illness script,” and their features, distinctions, and components

Author	year
Custers et al.	(1996)^Citation26
Custers et al.	(1996)^Citation28
Custers et al.	(1998)^Citation24
Custers et al.	(2015)^Citation27
Loftus	(2006)^Citation5
Charlin	(2000)^Citation12

Table 4 The studies that deal with the formation and development of “illness script” during the acquisition of expertise and changes in the physician’s knowledge structure

Author	year
Schmidt et al.	(1990)^Citation25
Schmidt et al.	(1984)^Citation23
Harasym et al.	(2008)^Citation29

Figure 2 Generic flow of events in a typical schema. D1: Decision No 1; D5: Decision No 6; F1: Finding No 1; F5: Finding No 5; H1: Hypothesis No 1; H2: Hypothesis No 2; I1: Inquiry No 1; I3: Inquiry No 3.

Figure 3 Script as a routinized pathway of previously used schema. D1: Decision No 1; D5: Decision No 6; F1: Finding No 1; F5: Finding No 5; H1: Hypothesis No 1; H2: Hypothesis No 2; I1: Inquiry No 1; I3: Inquiry No 3.

Feinstein AR. An analysis of diagnostic reasoning. 3. The construction of clinical algorithms. Yale J Biol Med. 1974;47(1):5.

 Web of Science ®Google Scholar

Rubin AD. Hypothesis formation and evaluation in medical diagnosis. 1975. Available from: https://dspace.mit.edu/handle/1721.1/6919.

 Google Scholar

Elstein AS, Shulman LS, Sprafka SA. Medical problem solving an analysis of clinical reasoning. Cambridge,US: Harvard University Press 1978.

 Google Scholar

Elstein A, Bordage G. Psychology or clinical reasoning. Stone G, Cohen F, Adler N, editors. Health psychology: a handbook. San Francisco: Jossey-Bass. 1979:335-367.

 Google Scholar

Kraytman M. The preparation of medical students in our country: some clinical observations. Acta clinica Belgica. 1981;36(5):223–226.

 Web of Science ®Google Scholar

Feltovich PJ, Patel VL. The Pursuit of Understanding in Clinical Reasoning. 1984.

 Google Scholar

Kuipers B, Kassirer JP. Causal reasoning in medicine: analysis of a protocol. Cogn Sci. 1984;8(4):363–385.

 Web of Science ®Google Scholar

Schmidt HG, de Volder ML. Tutorials in Problem-based Learning: New Directions in Training for the Health Professions. 1st International Symposium. Van Gorcum; 1984.

 Google Scholar

McGuire CH. Medical problem-solving: a critique of the literature. J Med Educ.1985: 60(8):587–95

 Google Scholar

Patel VL, Groen GJ. Knowledge based solution strategies in medical reasoning. Cogn Sci. 1986;10(1):91–116.

 Web of Science ®Google Scholar

Barrows HS, Feltovich PJ. The clinical reasoning process. Med Educ. 1987;21(2):86–91.

 PubMed Web of Science ®Google Scholar

Case S, Swanson D, Stillman P Evaluating diagnostic pattern recognition: the psychometric characteristics of a new item format. Paper presented at: Research in medical education: proceedings of the … annual Conference. Conference on Research in Medical Education; United States: Whashington, DC; 1987.

 Google Scholar

Hamm RM. Clinical intuition and clinical analysis: expertise and the cognitive continuum. In: Professional Judgment: A Reader in Clinical Decision Making. Cambridge, UK: Cambridge University Press; 1988:78–105.

 Google Scholar

Groen GJ, Patel VL. The relationship between comprehension and reasoning in medical expertise. In: In M. T. H. Chi, R. Glaser, & M. J. Farr (Eds.), The nature of expertise . Hillsdale, NJ, US: Lawrence Erlbaum Associates, Inc1988: 287–310

 Google Scholar

Girotto V, Legrenzi P. Mental representation and hypothetico-deductive reasoning: The case of the THOG problem. Psychol Res. 1989;51(3):129–135.

 Web of Science ®Google Scholar

Elstein AS, Shulman LS, Sprafka SA. Medical problem solving a ten-year retrospective. Eval Health Prof. 1990;13(1):5–36.

 Web of Science ®Google Scholar

Joseph G-M, Patel VL. Domain knowledge and hypothesis genenation in diagnostic reasoning. Med Decis Making. 1990;10(1):31–44.

 Web of Science ®Google Scholar

Patel VL, Groen GJ, Arocha JF. Medical expertise as a function of task difficulty. Mem Cognit. 1990;18(4):394–406.

 PubMed Web of Science ®Google Scholar

Norman GG, Patel V, Schmidt HH. Clinical inquiry and scientific inquiry. Med educ. 1990;24(4):396–399.

 Web of Science ®Google Scholar

Schmidt H, Norman G, Boshuizen H. A cognitive perspective on medical expertise: theory and implication [published erratum appears in Acad Med 1992 Apr; 67 (4): 287]. Acad med. 1990;65(10):611–621.

 PubMed Web of Science ®Google Scholar

Ericsson KA, Smith J. Toward a general theory of expertise: Prospects and limits. New York, US: Cambridge University Press; 1991.

 Google Scholar

Kaufman SG. A Formal Theory of Spatial Reasoning. In Allen J, Fikes RE, Sandewall E..Principles of Knowledge Representation and Reasoning: Proceedings of the Second International Conference. Morgan Kaufmann Publishers.1991.

 Google Scholar

Mattingly C. The narrative nature of clinical reasoning. Am J Occup Ther. 1991;45(11):998–1005.

 PubMed Web of Science ®Google Scholar

Custers EJ. The Relationship between Medical Expertise and the Development of Illness-Scripts. 1992-Apr. Belgium; Netherlands

 Google Scholar

Evans C, Kakas AC. Hypothetico-deductive Reasoning. Paper presented at: Fifth Generation Computer Systems. 1992. Tokyo, Japan

 Google Scholar

Florance V. Medical knowledge for clinical problem solving: a structural analysis of clinical questions. Bull Med Libr Assoc. 1992;80(2):140.

 Google Scholar

Boshuizen HP, Schmidt HG. On the role of biomedical knowledge in clinical reasoning by experts, intermediates and novices. Cogn Sci. 1992;16(2):153–184.

 Web of Science ®Google Scholar

Higgs J. Developing clinical reasoning competencies. Physiotherapy. 1992;78(8):575–581.

 Google Scholar

Arocha JF, Patel VL, Patel YC. Hypothesis generation and the coordination of theory and evidence in novice diagnostic reasoning. Med Decis Making. 1993;13(3):198–211.

 Web of Science ®Google Scholar

Hassebrock F, Johnson PE, Bullemer P, Fox PW, Moller JH. When less is more: Representation and selective memory in expert problem solving. Am J Psychol. 1993:155–189.

 Web of Science ®Google Scholar

Patel VL, Groen GJ, Norman GR. Reasoning and instruction in medical curricula. Cogn Instr. 1993;10(4):335–378.

 Web of Science ®Google Scholar

Schmidt HG, Boshuizen HP. On acquiring expertise in medicine. Educ Psychol Rev. 1993;5(3):205–221.

 Web of Science ®Google Scholar

Higgs J. A programme for developing clinical reasoning skills in graduate physiotherapists. Med teach. 1993;15(2–3):195–205.

 PubMed Web of Science ®Google Scholar

Arocha JF, Patel VL, Patel YC. Hypothesis generation and the coordination of theory and evidence in novice diagnostic reasoning. Med Decis Making: an international journal of the Society for Medical Decision Making. Jul-Sep 1993;13(3):198–211.

 Web of Science ®Google Scholar

Bordage G. Elaborated knowledge: a key to successful diagnostic thinking. Acad Med. 1994.

 Web of Science ®Google Scholar

Elstein AS. What goes around comes around: return of the hypothetico‐deductive strategy. TEACH LEARN MED: An International Journal. 1994;6(2):121–123.

 Google Scholar

Patel V, Arocha JF, Kaufman D. Diagnostic reasoning and medical expertise.In. Medin, DL Advances in Research and Theory . 1994;31(C):187–252.

 Web of Science ®Google Scholar

Jones M. Clinical reasoning and pain. Man Ther. 1995;1(1):17–24.

 Google Scholar

Arocha JF, Patel VL. Novice diagnostic reasoning in medicine: accounting for evidence. J Learn Sci. 1995;4(4):355–384.

 Web of Science ®Google Scholar

Custers EJFM. The development and function of illness scripts: studies on the structure of medical diagnostic knowledge. Thesis. Maastricht University; 1995.

 Google Scholar

Custers EJ, Boshuizen HP, Schmidt HG. The influence of medical expertise, case typicality, and illness script component on case processing and disease probability estimates. Mem Cognit. 1996;24(3):384–399.

 PubMed Web of Science ®Google Scholar

Custers E, Regehr G, Norman GR. Mental representations of medical diagnostic knowledge: a review. Acad Med. 1996;71(10):S55–61.

 Web of Science ®Google Scholar

Hammond KR. Human Judgment and Social Policy: Irreducible Uncertainty, Inevitable Error, Unavoidable Injustice. New York: Oxford University Press; 1996.

 Google Scholar

Mandin H, Jones A, Woloschuk W, Harasym P. Helping students learn to think like experts when solving clinical problems. Acad med: journal of the Association of American Medical Colleges. 1997;72(3):173–179.

 PubMed Web of Science ®Google Scholar

Van de Wiel M. Knowledge encapsulation:Studies on the deve;opment of medical expertise. thesis.Maastricht university, 1997.

 Google Scholar

Allen VG, Arocha JF, Patel VL. Evaluating evidence against diagnostic hypotheses in clinical decision making by students, residents and physicians. Int J Med Inform. Aug-Sep 1998;51(2–3):91–105.

 Web of Science ®Google Scholar

Chang RW, Bordage G, Connell KJ. COGNITION, CONFIDENCE, AND CLINICAL SKILLS: the importance of early problem representation during case presentations. Acad Med. 1998;73(10):S109–111.

 Web of Science ®Google Scholar

Charlin B. Script questionnaires: their use for assessment of diagnostic knowledge in radiology. Med Teach. 1998;20(6):567–571.

 Web of Science ®Google Scholar

Custers EJ, Boshuizen HP, Schmidt HG. The role of illness scripts in the development of medical diagnostic expertise: Results from an interview study. Cogn Instr. 1998;16(4):367–398.

 Web of Science ®Google Scholar

Cuthbert L, Duboulay, B., Teather, D., Teather, B., Sharples, M., & Duboulay, G. . Expert/novice differences in diagnostic medical cognition-A review of the literature. University of Sussex Cognitive Science Research paper CSRP #508, Feb. 1999, ISSN 1350–3162.

 Google Scholar

Kaufman DR, Kushniruk AW, Yale JF, Patel VL. Conceptual knowledge and decision strategies in relation to hypercholesterolemia and coronary heart disease. Int J Med Inform. Nov 1999;55(3):159–177.

 Web of Science ®Google Scholar

Round AP. Teaching clinical reasoning--a preliminary controlled study. Med Educ. Jul 1999;33(7):480–483.

 Web of Science ®Google Scholar

Charlin B, Tardif J, Boshuizen H. Scripts and medical diagnostic knowledge: theory and applications for clinical reasoning instruction and research. Acad Med. 2000;75(2):182–190.

 PubMed Web of Science ®Google Scholar

Carter MA, & Robinson, S. S. A narrative approach to the clinical reasoning process in pediatric intensive care: The story of Matthew. J Med Humanit. 2001;22(3):173–194.

 Google Scholar

Harries PA, Harries C. Studying clinical reasoning, part 2: Applying social judgement theory. Br J Occup Ther. 2001;64(6):285–292.

 Google Scholar

Round A. Introduction to clinical reasoning. J Eval Clin Pract. 2001.

 Web of Science ®Google Scholar

Elstein AS, Schwartz A. Clinical problem solving and diagnostic decision making: selective review of the cognitive literature. BMJ (Clinical research ed.). Mar 23 2002;324(7339):729–732.

 PubMed Web of Science ®Google Scholar

Nendaz MR, Bordage G. Promoting diagnostic problem representation. Med Educ. Aug 2002;36(8):760–766.

 PubMed Web of Science ®Google Scholar

Patel VL, Arocha JF, Kushniruk AW. Patients' and physicians' understanding of health and biomedical concepts: relationship to the design of EMR systems. J Biomed Inform. Feb 2002;35(1):8–16.

 Web of Science ®Google Scholar

Bleakley A, Farrow R, Gould D, Marshall R. Making sense of clinical reasoning: judgement and the evidence of the senses. Med Educ. Jun 2003;37(6):544–552.

 Web of Science ®Google Scholar

Coderre S, Mandin H, Harasym PH, Fick GH. Diagnostic reasoning strategies and diagnostic success. Med Educ. Aug 2003;37(8):695–703.

 PubMed Web of Science ®Google Scholar

Norman GR, Eva KW. Doggie diagnosis, diagnostic success and diagnostic reasoning strategies: an alternative view. Med Educ. Aug 2003;37(8):676–677.

 Web of Science ®Google Scholar

Eshach H, Bitterman H. From case-based reasoning to problem-based learning. Acad Med: journal of the Association of American Medical Colleges. May 2003;78(5):491–496.

 PubMed Web of Science ®Google Scholar

Groves M, O'Rourke P, Alexander H. Clinical reasoning: the relative contribution of identification, interpretation and hypothesis errors to misdiagnosis. Med Teach. Nov 2003;25(6):621–625.

 PubMed Web of Science ®Google Scholar

Hardin LE. Research in medical problem solving: a review. J Vet Med Educ. Fall 2003;30(3):230–235.

 PubMed Web of Science ®Google Scholar

Charlin B, van der Vleuten C. Standardized assessment of reasoning in contexts of uncertainty: the script concordance approach. Eval Health Prof. Sep 2004;27(3):304–319.

 PubMed Web of Science ®Google Scholar

Eva KW. What every teacher needs to know about clinical reasoning. Med Educ. Jan 2005;39(1):98–106.

 PubMed Web of Science ®Google Scholar

Rikers RM, Van Gerven PW, Schmidt HG. Cognitive load theory as a tool for expertise development. Instr Sci. 2004;32(1–2):173–182.

 Web of Science ®Google Scholar

Verkoeijen PP, Rikers RM, Schmidt HG, van de Wiel MW, Kooman JP. Case representation by medical experts, intermediates and novices for laboratory data presented with or without a clinical context. Med Educ. Jun 2004;38(6):617–627.

 PubMed Web of Science ®Google Scholar

Holyoak KJ, Morrison R. The Cambridge Handbook of Thinking and Reasoning. Cambridge, UK: Cambridge University Press; 2005.

 Google Scholar

Norman G. Research in clinical reasoning: past history and current trends. Med educ. 2005;39(4):418–427.

 PubMed Web of Science ®Google Scholar

Tamayo-Sarver JH, Dawson NV, Hinze SW, Cydulka RK, Wigton RS, Baker DW. Rapid clinical decisions in context: a theoretical model to understand physicians’ decision-making with an application to racial/ethnic treatment disparities. Health Care Services, Racial and Ethnic Minorities and Underserved Populations: Patient and Provider Perspectives: Emerald Group Publishing Limited; 2005:183–213.

 Google Scholar

Anderson KJ. Factors affecting the development of undergraduate medical students' clinical reasoning ability. Thesis. The university Adelaide. 2006.

 Google Scholar

Bowen JL. Educational strategies to promote clinical diagnostic reasoning. N Engl J Med. Nov 23 2006;355(21):2217–2225.

 PubMed Web of Science ®Google Scholar

Eva KW, Cunnington JP. The difficulty with experience: does practice increase susceptibility to premature closure? J Contin Educ Health Prof. Summer 2006;26(3):192–198.

 Google Scholar

Loftus SF. Language in Clinical Reasoning: Learning and Using the Language of Collective Clinical Decision Making.Sydney, Australia: University of Sydney. 2006

 Google Scholar

Mongtomery K. How doctors think: Clinical judgment and the practice of medicine. Oxford, United states: New York: Oxford University Press; 2005.

 Google Scholar

Novak K, Mandin H, Wilcox E, McLaughlin K. Using a conceptual framework during learning attenuates the loss of expert-type knowledge structure. BMC Med Educ. Jul 18 2006;6:37.

 PubMedGoogle Scholar

Thornton T. Tacit knowledge as the unifying factor in evidence based medicine and clinical judgement. PHILOS ETHICS HUM ME. Mar 17 2006;1(1):E2.

 Google Scholar

Auclair F. Problem formulation by medical students: an observation study. BMC med educ. Jun 17 2007;7:16.

 PubMedGoogle Scholar

Schmidt HG, Rikers RM. How expertise develops in medicine: knowledge encapsulation and illness script formation. Med Educ. Dec 2007;41(12):1133–1139.

 PubMed Web of Science ®Google Scholar

Norman G, Young M, Brooks L. Non‐analytical models of clinical reasoning: the role of experience. Med educ. 2007;41(12):1140–1145.

 PubMed Web of Science ®Google Scholar

Banning M. A review of clinical decision making: models and current research. J Clin Nurs. Jan 2008;17(2):187–195.

 PubMed Web of Science ®Google Scholar

Evans JSB. Dual-processing accounts of reasoning, judgment, and social cognition. Annu. Rev. Psychol. 2008;59:255–278.

 PubMed Web of Science ®Google Scholar

Harasym PH, Tsai T-C, Hemmati P. Current trends in developing medical students' critical thinking abilities. Kaohsiung J Med Sci. 2008;24(7):341–355.

 PubMed Web of Science ®Google Scholar

Heiberg Engel PJ. Tacit knowledge and visual expertise in medical diagnostic reasoning: implications for medical education. Med Teach. 2008;30(7):e184–188.

 PubMed Web of Science ®Google Scholar

Higgs J, Jones M, Loftus S, Christensen N. Clinical Reasoning in the Health Professions. 3rd ed. Philadelphia, PA: Elsevier Health Sciences; 2008.

 Google Scholar

Humbert A. 15 Assessing the Clinical Reasoning Skills of Emergency Medicine Clerkship Students Using a Script Concordance Test. Acad Emerg Med. 2008;15:S230–S231.

 Google Scholar

Aleluia IM, Carvalho PM, Jr., Menezes MS. A way to assess students' clinical reasoning. Med Educ. Nov 2010;44(11):1145–1146.

 Web of Science ®Google Scholar

Corcoran J, Walsh J. Clinical assessment and diagnosis in social work practice. Oxford, United states: New York: Oxford University; 2010.

 Google Scholar

Mariasin M. Novice, Generalist, and Expert Reasoning During Clinical Case Explanation: A Propositional Assessment of Knowledge Utilization and Application, thesis.University of Waterloo; 2010.

 Google Scholar

Lee A, Joynt GM, Lee AK, et al. Using illness scripts to teach clinical reasoning skills to medical students. Fam Med. 2010;42(4):255–261.

 PubMed Web of Science ®Google Scholar

Elizondo-Omana RE, Morales-Gomez JA, Morquecho-Espinoza O, et al. Teaching skills to promote clinical reasoning in early basic science courses. Anat Sci Educ. Sep-Oct 2010;3(5):267–271.

 Web of Science ®Google Scholar

Wilhelmsson N. From basic science knowledge to clinical understanding. Thesis. Karolinska Institutet,2010.

 Google Scholar

Thomson O, Petty N, J, Moore A. Clinical reasoning in osteopathy e More than just principles? Int J Osteopath Med. 2011;14: 71–76.

 Web of Science ®Google Scholar

Amini M, Moghadami M, Kojuri J, et al. An innovative method to assess clinical reasoning skills: Clinical reasoning tests in the second national medical science Olympiad in Iran. BMC Res Notes. Oct 17 2011;4:418.

 PubMedGoogle Scholar

Durning S, Artino AR, Jr., Pangaro L, van der Vleuten CP, Schuwirth L. Context and clinical reasoning: understanding the perspective of the expert's voice. Med Educ. Sep 2011;45(9):927–938.

 PubMed Web of Science ®Google Scholar

Franklin A, Liu Y, Li Z, et al. Opportunistic decision making and complexity in emergency care. J Biomed Inform. Jun 2011;44(3):469–476.

 Web of Science ®Google Scholar

Pelaccia T, Tardif J, Triby E, Charlin B. An analysis of clinical reasoning through a recent and comprehensive approach: the dual-process theory. Med educ online. 2011;16.

 Web of Science ®Google Scholar

Adams JR, Elwyn G, Legare F, Frosch DL. Communicating with physicians about medical decisions: a reluctance to disagree. Arch Intern Med. Aug 13 2012;172(15):1184–1186.

 Google Scholar

Ashoorion V, Liaghatdar MJ, Adibi P. What variables can influence clinical reasoning? J Res Med Sci: the official journal of Isfahan University of Medical Sciences. 2012;17(12):1170.

 Google Scholar

van Bruggen L, Manrique-van Woudenbergh M, Spierenburg E, Vos J. Preferred question types for computer-based assessment of clinical reasoning: a literature study. Perspect Med Educ. Nov 2012;1(4):162–171.

 Google Scholar

Charlin B, Lubarsky S, Millette B, et al. Clinical reasoning processes: unravelling complexity through graphical representation. Med Educ. May 2012;46(5):454–463.

 PubMed Web of Science ®Google Scholar

Demirören M, Palaoğlu Ö. Assessment of Medical Student’s Clinical Reasoning Skills in the Problem Based Learning-Integrated Curriculum. J Ankara Univ Fac Med. 2012, 65 (2)

 Google Scholar

Braude HD. Intuition in medicine: A philosophical defense of clinical reasoning. US: Chicago: University of Chicago Press; 2012.

 Google Scholar

Braude HD. Conciliating cognition and consciousness: the perceptual foundations of clinical reasoning. J Eval Clin Pract. 2012;18(5):945–950.

 Web of Science ®Google Scholar

Khatami S, MacEntee MI, Pratt DD, Collins JB. Clinical reasoning in dentistry: a conceptual framework for dental education. J Dent Educ. Sep 2012;76(9):1116–1128.

 Web of Science ®Google Scholar

Lucchiari C, Pravettoni G. Cognitive balanced model: a conceptual scheme of diagnostic decision making. J Eval Clin Pract. 2012;18(1):82–88.

 Web of Science ®Google Scholar

Loftus S. Rethinking clinical reasoning: time for a dialogical turn. Med educ. 2012;46(12):1174–1178.

 PubMed Web of Science ®Google Scholar

Marcum JA. An integrated model of clinical reasoning: dual‐process theory of cognition and metacognition. J Eval Clin Pract. 2012;18(5):954–961.

 PubMed Web of Science ®Google Scholar

Nouh T, Boutros M, Gagnon R, et al. The script concordance test as a measure of clinical reasoning: a national validation study. Am J Surg. Apr 2012;203(4):530–534.

 Web of Science ®Google Scholar

Shaban R. Theories of clinical judgment and decision-making: A review of the theoretical literature. AJP. 2015;3(1).

 Google Scholar

Adams L. Clinical Reasoning and Causal Attribution in Medical Diagnosis.Thesis. University of Plymouth. 2013.

 Google Scholar

Custers EJ. Medical education and cognitive continuum theory: an alternative perspective on medical problem solving and clinical reasoning. Acad Med. 2013;88(8):1074–1080.

 PubMed Web of Science ®Google Scholar

Audetat MC, Laurin S, Sanche G, et al. Clinical reasoning difficulties: a taxonomy for clinical teachers. Med Teach. 2013;35(3):e984–989.

 PubMed Web of Science ®Google Scholar

Da Silva A. Clinical reasoning development in medical students: An educational and transcultural comparative study, PhD thesis, University of; 2013.

 Google Scholar

Evans JSB, Stanovich KE. Dual-process theories of higher cognition advancing the debate. Perspect Psychol Sci. 2013;8(3):223–241.

 PubMedGoogle Scholar

Gigante J. Teaching Clinical Reasoning Skills to Help your Learners “Get” the Diagnosis. Pediat Therapeut, 2013;3(4).

 Google Scholar

Kriewaldt J, Turnidge D. Conceptualising an approach to clinical reasoning in the education profession. AJTE. 2013;38(6):7.

 Google Scholar

Lubarsky S, Dory V, Duggan P, Gagnon R, Charlin B. Script concordance testing: from theory to practice: AMEE guide no. 75. Med Teach. 2013;35(3):184–193.

 PubMed Web of Science ®Google Scholar

Munshi FM, AlJarallah BM, Harasym PH. Problem Solving Strategy and Diagnostic Performance at Three Expertise Levels: Does the Problem Solving Approach Matter? J Health Educ Res Dev. 2013.

 Google Scholar

Smith M, Loftus S, Levett-Jones T. Teaching clinical reasoning.In: Loftus, S., Gerzina, T., Higgs, J., Smith, M., & Duffy, E. Educating Health Professionals: Dordrecht, Netherlands: SensePublishers; 2013:269–276.

 Google Scholar

Weiss MJ, Bhanji F, Fontela PS, Razack SI. A preliminary study of the impact of a handover cognitive aid on clinical reasoning and information transfer. Med Educ. Aug 2013;47(8):832–841.

 Web of Science ®Google Scholar

Ilgen JS, Bowen JL, McIntyre LA, et al. Comparing diagnostic performance and the utility of clinical vignette-based assessment under testing conditions designed to encourage either automatic or analytic thought. Acad Med. Oct 2013;88(10):1545–1551.

 PubMed Web of Science ®Google Scholar

Facione NC, Facione PA. Critical thinking and clinical judgment. Critical thinking and clinical reasoning in the health sciences: A teaching anthology. US, Millbrae, California Academic Press, 2008:1–13.

 Google Scholar

Vertue FM, Haig BD. An abductive perspective on clinical reasoning and case formulation. J Clin Psychol. Sep 2008;64(9):1046–1068.

 Web of Science ®Google Scholar

Braude HD. Clinical intuition versus statistics: different modes of tacit knowledge in clinical epidemiology and evidence-based medicine. Theor Med Bioeth. 2009;30(3):181–198.

 Web of Science ®Google Scholar

Bissessur SW, Geijteman EC, Al-Dulaimy M, et al. Therapeutic reasoning: from hiatus to hypothetical model. J Eval Clin Pract. Dec 2009;15(6):985–989.

 PubMed Web of Science ®Google Scholar

Carriere B, Gagnon R, Charlin B, Downing S, Bordage G. Assessing clinical reasoning in pediatric emergency medicine: validity evidence for a Script Concordance Test. Annals of emergency medicine. May 2009;53(5):647–652.

 Web of Science ®Google Scholar

Croskerry P. Clinical cognition and diagnostic error: applications of a dual process model of reasoning. Adv Health Sci Educ. 2009;14(1):27–35.

 PubMed Web of Science ®Google Scholar

Croskerry P. A universal model of diagnostic reasoning. Acad med. 2009;84(8):1022–1028.

 PubMed Web of Science ®Google Scholar

Elstein AS. Thinking about diagnostic thinking: a 30-year perspective. Adv Health Sci Educ Theory Pract. 2009;14(1):7–18.

 Web of Science ®Google Scholar

Stempsey WE. Clinical reasoning: new challenges. Theor Med Bioeth. 2009;30(3):173–179.

 PubMed Web of Science ®Google Scholar

Rehder B, Kim S. Classification as diagnostic reasoning. Mem Cognit. 2009;37(6):715–729.

 Web of Science ®Google Scholar

Vosniadou S. International handbook of research on conceptual change. United states: New York. Routledge; 2009.

 Google Scholar

L. Bowen J, S. Ilgen J. Now You See It, Now You Don't: What Thinking Aloud Tells Us About Clinical Reasoning. J Grad Med Educ. 2014;6(4):783–785.

 Google Scholar

Delany C, Golding C. Teaching clinical reasoning by making thinking visible: an action research project with allied health clinical educators. BMC Med Educ. Jan 30 2014;14:20.

 PubMed Web of Science ®Google Scholar

Freiwald T, Salimi M, Khaljani E, Harendza S. Pattern recognition as a concept for multiple-choice questions in a national licensing exam. BMC Med Educ. 2014;14(1):232.

 PubMed Web of Science ®Google Scholar

Geisler PR, Hummel C, Piebes S. Evaluating evidence-informed clinical reasoning proficiency in oral practical examinations. Athl Train Educ J. 2014;9(1):43–48.

 Google Scholar

Gordon M. Manual of nursing diagnosis. Jones & Bartlett Publishers; 2014.

 Google Scholar

Holmboe ES, Durning SJ. Assessing clinical reasoning: moving from in vitro to in vivo. Diagnosis (Berlin, Germany). Jan 1 2014;1(1):111–117.

 PubMedGoogle Scholar

Hrynchak P, Takahashi SG, Nayer M. Key-feature questions for assessment of clinical reasoning: a literature review. Med Educ. Sep 2014;48(9):870–883.

 PubMed Web of Science ®Google Scholar

Hochberg L, Alm CO, Rantanen EM, DeLong CM, Haake A. Decision style in a clinical reasoning corpus. Proceedings of BioNLP 2014. USA. Baltimore, Maryland 2014:83–87.

 Google Scholar

Hochberg L, Alm CO, Rantanen EM, Yu Q, DeLong CM, Haake A. Towards automatic annotation of clinical decision-making style. Paper presented at: Proceedings of LAW VIII-The 8th Linguistic Annotation Workshop. Ireland, Dublin, 2014.

 Google Scholar

Monajemi A. The Role of Biomedical Knowledge in Clinical Reasoning: Bridging the Gap between Two Theories.  IJBMC. 2014;1(2):102–106.

 Google Scholar

Roots, S. A. Clinical reasoning in osteopathy: an investigation of diagnostic hypothesis generation for patients with acute low back pain . Thesis. Unitec Institute of Technology. 2014.

 Google Scholar

Salkeld EJ. Framework negotiations: diagnostic insights among alternative medical practitioners participating in integrative medicine case conferences. Med Anthropol Q. Mar 2014;28(1):44–65.

 Web of Science ®Google Scholar

Smith CS, Hill W, Francovich C, et al. Diagnostic Reasoning across the Medical Education Continuum. Healthcare (Basel, Switzerland). Jul 15 2014;2(3):253–271.

 Google Scholar

Capaldi VF, Durning SJ, Pangaro LN, Ber R. The clinical integrative puzzle for teaching and assessing clinical reasoning: preliminary feasibility, reliability, and validity evidence. Mil Med. Apr 2015;180(4 Suppl):54–60.

 Web of Science ®Google Scholar

Custers EJ. Thirty years of illness scripts: Theoretical origins and practical applications. Med teach. 2015;37(5):457–462.

 PubMed Web of Science ®Google Scholar

Gaba A. Teaching Clinical Judgment: A Review with Consideration of Applications for Health Professions. Open Nutr J. 2015;9(1).

 Google Scholar

Islam R, Weir CR, Jones M, Del Fiol G, Samore MH. Understanding complex clinical reasoning in infectious diseases for improving clinical decision support design. BMC Med Inform Decis Mak. Nov 30 2015;15:101.

 PubMed Web of Science ®Google Scholar

Lafleur A, Cote L, Leppink J. Influences of OSCE design on students' diagnostic reasoning. Med Educ. Feb 2015;49(2):203–214.

 PubMed Web of Science ®Google Scholar

Lubarsky S, Dory V, Audetat MC, Custers E, Charlin B. Using script theory to cultivate illness script formation and clinical reasoning in health professions education. Can Med Educ J. 2015;6(2):e61–70.

 PubMedGoogle Scholar

Park WB, Kang SH, Lee YS, Myung SJ. Does Objective Structured Clinical Examinations Score Reflect the Clinical Reasoning Ability of Medical Students? Am J Med Sci. Jul 2015;350(1):64–67.

 Google Scholar

Lisk K, Agur AM, Woods NN. Exploring cognitive integration of basic science and its effect on diagnostic reasoning in novices. Perspect Med Educ. Jun 2016;5(3):147–153.

 PubMedGoogle Scholar

McBee E, Ratcliffe T, Goldszmidt M, et al. Clinical Reasoning Tasks and Resident Physicians: What Do They Reason About? Acad Med : journal of the Association of American Medical Colleges. Jul 2016;91(7):1022–1028.

 Google Scholar

Gruppen LD. Clinical Reasoning: Defining It, Teaching It, Assessing It, Studying It. West J Emerg Med. Jan 2017;18(1):4–7.

 PubMedGoogle Scholar

Haring CM, et al. Observable phenomena that reveal medical students' clinical reasoning ability during expert assessment of their history taking: a qualitative study. . BMC med educ. 2017;17(1):147.

 Web of Science ®Google Scholar

Jarodzka H, Boshuizen HP. Unboxing the Black Box of Visual Expertise in Medicine. Frontline learn research. 2017;5(3):167–183.

 Google Scholar

Norman GR, Monteiro SD, Sherbino J, Ilgen JS, Schmidt HG, Mamede S. The Causes of Errors in Clinical Reasoning: Cognitive Biases, Knowledge Deficits, and Dual Process Thinking Acad Med: journal of the Association of American Medical Colleges. Jan 2017;92(1):23–30.

 Google Scholar

ten Cate O, Durning SJ. Understanding Clinical Reasoning from Multiple Perspectives: A Conceptual and Theoretical Overview. In: ten Cate O, Custers E, Durning SJ, eds. Principles and Practice of Case-based Clinical Reasoning Education: A Method for Preclinical Students. Switzerlan, Cham, Springer: 2018:35–46.

 Google Scholar

Zamani S, Amini M, Masoumi SZ, Delavari S, Namaki MJ, Kojuri J. The comparison of the key feature of clinical reasoning and multiple choice examinations in clinical decision makings ability. Biomed Re. 2017;28(3):1115–1119.

 Google Scholar

Bowen JL, ten Cate O. Prerequisites for Learning Clinical Reasoning. In: ten Cate O, Custers E, Durning SJ, eds. Principles and Practice of Case-based Clinical Reasoning Education: A Method for Preclinical Students. Switzerlan, Cham, Springer. 2018:47–63.

 Google Scholar

Custers EJ. Training Clinical Reasoning: Historical and Theoretical Background.In: In: ten Cate O, Custers E, Durning SJ, eds. Principles and Practice of Case-based Clinical Reasoning Education: A Method for Preclinical Students. Switzerlan, Cham, Springer; 2018:21–33.

 Google Scholar

Daly P. A concise guide to clinical reasoning. J Eval Clin Pract. 2018;24(5):966–972.

 Web of Science ®Google Scholar

King L, Kremser S, Deam P, et al. Clinical reasoning in osteopathy: Experiences of novice and experienced practitioners. INT J OSTEOPATH MED. 2018;28:12–19.

 Web of Science ®Google Scholar

Keemink Y, Custers E, van Dijk S, Ten Cate O. Illness script development in pre-clinical education through case-based clinical reasoning training. Int J Med Educ. Feb 9 2018;9:35–41.

 Web of Science ®Google Scholar

Lopes HF, Polson NG. Bayesian hypothesis testing: Redux. Cornel university.arXiv preprint arXiv:1808.08491. 2018.

 Google Scholar

Yazdani S, Abardeh MH. Clinical Reasoning in Medicine: A Concept Analysis. JMED. 2017;16(3).

 Google Scholar

Yazdani S, Hosseinzadeh M, Hosseini F. Models of clinical reasoning with a focus on general practice: A critical review. J Adv Med Educ Prof. Oct 2017;5(4):177–184.

 PubMedGoogle Scholar

Higgs J. Judgment and reasoning in professional contexts. In: Lanzer, P. ed., 2018. Textbook of Catheter-Based Cardiovascular Interventions: A Knowledge-Based Approach. Springer. 2018:15–25.

 Google Scholar