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Med Teach. 2019 Nov;41(11):1277-1284. doi: 10.1080/0142159X.2019.1635686. Epub 2019 Jul 17.

The terminology of clinical reasoning in health professions education: Implications and considerations.

Author information

Department of Medicine, McGill University , Montreal , Canada.
Institute for Health Sciences Education, McGill University , Montreal , Canada.
School of Physical and Occupational Therapy, McGill University , Montreal , Canada.
Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal , Montreal , Canada.
Division of Emergency Medicine, Department of Surgery, Duke University School of Medicine , Durham , NC , USA.
Department of Medical Education, University of Michigan , Ann Arbor , MI , USA.
Department of Neurology, McGill University , Montreal , Canada.
School of Medicine, Tufts University , Boston , MA , USA.
Division of General Internal Medicine, Tufts Medical Center , Boston , MA , USA.
Accreditation Council for Graduate Medical Education , Chicago , IL , USA.
Department of Medicine, Yale School of Medicine, Yale University , New Haven , CT , USA.
Feinberg School of Medicine, Northwestern University , Chicago , Illinois , USA.
Swansea University Medical School, Swansea University , Swansea , UK.
Department of Medicine, University of Texas Health Science Center , San Antonio , TX , USA.
Flinders University Prideaux Centre for Research in Health Professions Education , Adelaide , Australia.
Department of Educational Development and Research, Maastricht University , Maastricht , the Netherlands.
Medical Education Research Centre, Chang Gung University , Taoyuan City , Taiwan, China.
Uniformed Services, University of the Health Sciences , Bethesda , MD , USA.


Introduction: Clinical reasoning is considered to be at the core of health practice. Here, we report on the diversity and inferred meanings of the terms used to refer to clinical reasoning and consider implications for teaching and assessment. Methods: In the context of a Best Evidence Medical Education (BEME) review of 625 papers drawn from 18 health professions, we identified 110 terms for clinical reasoning. We focus on iterative categorization of these terms across three phases of coding and considerations for how terminology influences educational practices. Results: Following iterative coding with 5 team members, consensus was possible for 74, majority coding was possible for 16, and full team disagreement existed for 20 terms. Categories of terms included: purpose/goal of reasoning, outcome of reasoning, reasoning performance, reasoning processes, reasoning skills, and context of reasoning. Discussion: Findings suggest that terms used in reference to clinical reasoning are non-synonymous, not uniformly understood, and the level of agreement differed across terms. If the language we use to describe, to teach, or to assess clinical reasoning is not similarly understood across clinical teachers, program directors, and learners, this could lead to confusion regarding what the educational or assessment targets are for "clinical reasoning."

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