How do you teach clinical reasoning?

How do you make a decision? I’ve been thinking about the factors that are involved when making a decision about treatment. If a consultation takes 10 minutes, how long do you have to spend on decision making? If you’re anything like me then you are already thinking about the different options while you’re asking questions and carrying out a clinical exam. How do you narrow down the options? At what point do you start to discuss the different treatment options?

Sorry, too many questions. Trying to bring this together gives us the following, all of which is against the clock.

Knowledge, experience, evidence and emotions all come together when making a decision. Quick decisions tend to be made on past experience or gut instinct. Thinking about the available information on a given subject takes a little longer, until you become more familiar with it – then it moves into the fast non-analytical thinking box.

So the aim of teaching is to bring all of this together, to allow students to develop from the analytical thinking into faster thinking. Right or wrong? Sometimes being more analytical is needed. Where cases are a little more complicated, or unusual. Thinking more slowly is sometimes a good thing and should be encouraged.

Teaching clinical reasoning brings together the same factors as real life – the difference being that teaching tends to be controlled with clear cut diagnoses. The best teaching can occur when clinicians are honest with students, discuss past errors and reflect on what happened and what could have happened.

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