Clinical reasoning as a threshold skill

Abstract

Background: Threshold skills are defined as new ways of thinking about and performing in a discipline. They represent transformed ways of thinking and doing that are pivotal to learners’ progress. Our aim was to establish whether clinical reasoning exhibited features of a threshold skill.

Methods: Twenty-five final-year medical students were interviewed with a five-question protocol about how they were learning clinical reasoning. Students’ responses were analyzed using a deductive method to identify features of threshold skills.

Results: Students’ descriptions of learning clinical reasoning exhibited five features: transformation, troublesomeness, integration, association with practice, and issues with transferability.

Conclusions: Viewing clinical reasoning as a threshold skill is a novel interpretation of its nature and has implications for learning, teaching, and research. Students can be reassured that, although initially troublesome, with practice, they will not only learn the skill but also how to use it more effectively. Teachers can help students to understand that clinical reasoning is difficult to learn and will require time and repeated practice under supervision to develop.

Acknowledgements

The authors would like to thank Dr Julie Timmermans, Senior Lecturer, Higher Education Department, University of Otago, Dunedin for guiding the authors through the complexity of threshold concepts and skills.

Assoc Professor Marcus Henning, Centre for Medical and Health Sciences Education, University of Auckland, Auckland, New Zealand and Professor Tim Wilkinson, Director, MB ChB program, Faculty of Medicine, University of Otago, Christchurch, New Zealand for providing helpful comments on early drafts of the manuscript.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.

Additional information

Notes on contributors

Ralph Pinnock

Ralph Pinnock, FRACP, MClin Ed, Head of the Dunedin School of Medicine Education Department, Dunedin School of Medicine, Dunedin, New Zealand.

Megan Anakin

Megan Anakin, PhD (Otago), Lecturer in the School of Medicine Education Department, Dunedin School of Medicine, Dunedin, New Zealand.

Madelyne Jouart

Madelyne Jouart, Medical Student, Dunedin School of Medicine, Dunedin, New Zealand.