Student experiences of learning clinical reasoning.

BACKGROUND: Students find learning clinical reasoning skills challenging. Viewing how students learn clinical reasoning skills from a sociocultural perspective, however, may allow helpful and unhelpful descriptions to be interpreted as experiences that promote or inhibit their participation in and opportunities to co-construct their clinical reasoning skills. METHODS: This interview study was conducted with 25 Year-6 undergraduate medical students. Interview data were first analysed thematically, and then the findings were analysed with the concepts of participation and co-construction. RESULTS: The themes identified were: (1) practising with undifferentiated patients; (2) teachers who were willing to make thinking explicit; (3) a lack of independence and involvement; (4) a lack of communication and feedback; and (5) confusion from different sources of information. When further analysed, the themes could be represented as points along a continuum of participating in, and co-constructing, clinical reasoning skills. DISCUSSION: Clinical educators will find the themes identified from students' experiences learning in a workplace environment helpful for understanding why some students may struggle to develop their clinical reasoning skills. An interpretation of findings from a sociocultural perspective offers a different approach for understanding students' difficulties when learning clinical reasoning: one where students are able to increase their participation in, and co-construction of, clinical reasoning in the context of working collaboratively to provide patient care. Students find learning clinical reasoning skills challenging.