Clinical reasoning difficulties: A taxonomy for clinical teachers

Background: Clinical reasoning is the cornerstone of medical practice. To date, there is no established framework regarding clinical reasoning difficulties, how to identify them, and how to remediate them. Aim: To identify the most common clinical reasoning difficulties as they present in residents' patient encounters, case summaries, or medical notes. To develop a guide to support medical educators' process of educational diagnosis and management in this area. Methods: We used a participatory action research method. We carried out eight iterative reflective cycles with a group of clinical teachers. The repeated phases of experimentation and observation were conducted by participants in their own clinical teaching setting. Our findings were tested and validated on both an individual and collective basis Results: We found five categories of clinical reasoning difficulties as they present in the clinical teaching settings. We identified indicators for each. Indicators may be different depending on the type of supervision. These findings were assembled and organized to construct a guide for clinical teachers. Conclusions: The guide should assist clinical teachers in detecting clinical reasoning difficulties during clinical teaching and in providing remediation that is tailored to the specific difficulty identified. Its development furthers our understanding of clinical reasoning difficulties and provides a useful tool.