Educational strategies to promote clinical diagnostic reasoning.

Copyright © 2006 Massachusetts Medical Society. Clinical teachers differ from clinicians in a fundamental way. They must simultaneously foster high-quality patient care and assess the clinical skills and reasoning of learners in order to promote their progress toward independence in the clinical setting.1 Clinical teachers must diagnose both the patient’s clinical problem and the learner’s ability and skill. To assess a learner’s diagnostic reasoning strategies effectively, the teacher needs to consider how doctors learn to reason in the clinical environment.2-4 Medical students in a classroom generally organize medical knowledge according to the structure of the curriculum. For example, if pathophysiology is taught according to organ systems, then the student’s knowledge will be similarly organized, and the recall will be triggered by questions related to specific organ systems or other contextual clues. In the clinical setting, the patient’s health and care are the focus. Clinical problems may involve many organ systems and may be embedded in the context of the patient’s story and questions. Thus, in the clinical setting, the student’s recall of basic science knowledge from the classroom is often slow, awkward, or absent. Only after learners make new connections between their knowledge and specific clinical encounters can they also make strong connections between clinical features and the knowledge stored in memory.5,6 This report focuses on how clinical teachers can facilitate the learning process to help learners make the transition from being diagnostic novices to becoming expert clinicians.