Developing, Maintaining, and Teaching Clinical Diagnostic Expertise

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Bruce Fisher MD
Liam Rourke, PhD

clinical diagnostic expertise, teaching and assessing clinical reasoning,


Understanding the process of expert clinical reasoning improves our ability to develop, practice, maintain, teach, and assess clinical diagnostic expertise. The dual process model describes a synergistic interplay of associative thinking and analytical reasoning. These complimentary processes facilitate the efficient abstraction of data from clinical presentations, the identification of key features, and the production of useful problem representations. These are compared unconsciously to prototypical cases stored in memory as illness scripts for a best match. A lack of a satisfactory match may stimulate a conscious, analytic analysis of discordance, ideally reducing bias and error and promoting further script development.

An awareness of this process and the use of existing observation and assessment techniques can enable both the teaching and the assessment of clinical reasoning. Learners can also be taught to use these techniques to help develop self-assessment of clinical reasoning performance. Teaching and assessing clinical reasoning in others stimulates clinician teachers to reflect on their own clinical reasoning and practice, serving as an effective form of continuous professional learning.

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