Clinical reasoning is a perennial focus of medical education, performance assessment, and study. It might be argued to be the defining characteristic of the profession. It is, however, a very complex and multi-faceted phenomenon that can create considerable confusion and cross-communication. Its importance makes it worthwhile to consider some of those complexities. Defining it Like the fable of the blind men and the elephant, each of whom, feeling a different part of the elephant, described it in very different ways, clinical reasoning is a vast, complex construct that is described and used in different ways by different people. There is no generally accepted definition of clinical reasoning and, indeed, many articles about clinical reasoning never define it explicitly; it is often assumed as a universally understood construct. For the present commentary, we can describe the clinical reasoning process as including the physician's integration of her own (biomedical and clinical) knowledge with initial patient information to form a case representation of the problem. The physician uses this problem representation to guide the acquisition of additional information and then, on the basis of this information, revises the problem representation. She repeats the information gathering – representation revision cycle until she reaches a threshold of confidence in that representation to support a final diagnosis and/or management actions.
Gruppen, L. (2017). Clinical Reasoning: De ning It, Teaching It, Assessing It, Studying It. Western Journal of Emergency Medicine, 18(1), 4–7. https://doi.org/10.5811/westjem.2016.11.33191