Using theory to interpret how senior clinicians define, learn, and teach clinical reasoning

Dual process theory and script theory have been used to understand and explain how students learn clinical reasoning. This study used these tools to interpret how experienced teachers described their definitions of clinical reasoning, their own history learning about clinical reasoning, and their methods of teaching clinical reasoning. Methods: Interview data from 14 senior clinicians were investigated thematically using a general inductive approach then interpreted using principles and concepts associated with dual process theory and script theory, including the concept of deliberate practice and script consciousness. Results and Discussion: Senior clinicians’ definitions of clinical reasoning were consistent with the literature. Few of them recalled being explicitly taught clinical reasoning. They identified teaching as a way to further develop their own clinical reasoning. They taught it opportunistically using an apprenticeship and role-modelling approach in clinical contexts. Their teaching techniques included supervised practice, reflection, think aloud, focused data collection guided by the clinical presentation, and iterative reasoning. Conclusion: Dual process theory, script theory, and the concepts of mindful practice and deliberate practice were found to be useful tools to understand how senior clinicians taught and learned clinical reasoning. These findings are guiding our clinical reasoning curriculum and faculty development programme.