Clinical Reasoning Skills

What distinguishes experts?

Experts have reduced the steps in clinical reasoning to an unconscious process involving the following steps:

• Identification of information that is clinically relevant to a diagnosis

• Proper interpretation of the information

• Development of hypotheses with a coherent explanation of the findings

• Refinement of hypotheses with targeted data collection

• Establishment of a working diagnosis

The expert level of clinical reasoning is achieved only after years of practice. Characteristics of experts include:

• Experts are superior in knowledge content, not basic mental capacities, and remember factual knowledge better.

• Experts use critical thinking in their area of specialty, with better problem representations (schemes or patterns of recognition).

• Experts work forward from the information they have. They are more able to filter extract relevant information from available data and to generate meaningful hypotheses.

• Experts have become experts through extensive practice (10,000 hours) building a body of knowledge, strategies, and experiences accumulated over many years.

Experts do not tend to use knowledge of basic sciences in arriving at a diagnosis. Biomedical knowledge can be used as a check on the validity of a diagnosis. Experts can apply biomedical knowledge as needed.

References:

Charlin B, Boshuizen HPA, Custers EJ, Feltovich PJ. Scripts and clinical reasoning. Med Educ. 2007;41:1178-84.

Groves M, O'Rourke P, Alexander H. Clinical reasoning: the relative contribution of identification, interpretation and hypothesis errors to misdiagnosis. Med Teach. 2003;25(6):621-5.

Kassirer JP. Teaching clinical reasoning: case-based and coached. Acad Med. 2010; 85:1118-1124.