Clinical reasoning is the process practitioners use to gather and interpret information, identify and compare possible explanations, make clinical judgements or decisions, and determine appropriate actions.
Clinical reasoning is closely related to terms such as clinical judgement, clinical decision-making and diagnostic reasoning. These terms are sometimes used interchangeably in the research, although they do not describe exactly the same process.
Educators should not assume that clinical reasoning will develop simply because students acquire more theoretical knowledge or spend more time in professional practice. It can be deliberately supported by making the reasoning process an explicit part of learning.
Instead of only asking students “What is the diagnosis?” or “What would you do?”, ask them:
The aim is to get students to practise the process of reasoning rather than simply produce the correct answer.
Deliberately teaching clinical reasoning improves students’ reasoning performance ➕➕➕➕ [1–4]. Evidence from medicine and nursing shows that students benefit when they are given structured opportunities to interpret information, compare possible explanations, make decisions and explain their reasoning.
The evidence is more consistent when students have sufficient disciplinary and clinical knowledge to work with increasingly authentic problems [1]. This supports introducing clinical reasoning early, but progressively increasing the complexity, ambiguity and independence of reasoning activities as students develop expertise.
A range of approaches can support clinical reasoning, including workshops, cases, structured reflection, simulation and virtual patients [1–5]. There is no compelling evidence that one particular delivery method is consistently superior. The important feature appears to be that students actively practise the reasoning process and receive feedback on it, rather than simply being exposed to clinical content or given the correct answer.
This summary is informed primarily by four systematic reviews with meta-analyses [1–4], with an additional meta-analysis examining different simulation approaches [5].
The broadest review included 50 studies of undergraduate medical students [1]. Most studies reported improvements following explicit clinical-reasoning instruction, but the pooled randomised evidence was highly heterogeneous and restricted to medicine ➕➕➕.
Two recent nursing meta-analyses reported moderate improvements in clinical reasoning [2,3]. The strongest of these included 11 studies in its clinical-reasoning analysis, had moderate heterogeneity and remained significant after adjustment for possible publication bias. We rate this review as high quality ➕➕➕➕.
A further simulation review reported a larger effect but had very high heterogeneity and was dominated by quasi-experimental studies, so we place less weight on its headline estimate [4].
Overall, the evidence provides reasonably strong confidence that clinical reasoning can be deliberately improved, but most quantitative evidence comes from medicine and nursing.
