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.

Clinical reasoning as a threshold skill.

Background: Threshold skills are defined as new ways of thinking about and performing in a discipline. They represent transformed ways of thinking and doing that are pivotal to learners' progress. Our aim was to establish whether clinical reasoning exhibited features of a threshold skill. Methods: Twenty-five final-year medical students were interviewed with a five-question protocol about how they were learning clinical reasoning. Students' responses were analyzed using a deductive method to identify features of threshold skills. Results: Students' descriptions of learning clinical reasoning exhibited five features: transformation, troublesomeness, integration, association with practice, and issues with transferability. Conclusions: Viewing clinical reasoning as a threshold skill is a novel interpretation of its nature and has implications for learning, teaching, and research. Students can be reassured that, although initially troublesome, with practice, they will not only learn the skill but also how to use it more effectively. Teachers can help students to understand that clinical reasoning is difficult to learn and will require time and repeated practice under supervision to develop.