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The "unconsciously competent" mind
Teaching clinical reasoning by making thinking visible: an action research project with allied health clinical educators. Delany C et al. BMC Medical Education 2014; 14(20).
Reviewed by Dan Richards


What was the study question?
Can experienced clinicians define their thinking routines to better teach clinical reasoning to their students? [Or, in the authors' words, "How can clinical educators learn to teach clinical reasoning, given it is second-nature to them, but inaccessible and unobservable to students?"]

How was the study done?
Twenty-one clinical educators from eight different health disciplines participated in this "action research"study in Melbourne, Australia. They were asked to define their own processes of clinical reasoning, to refine the steps into a "thinking routine" that students could employ, to trial these routines with their students, and to reflect upon, further refine, and re-trial these routines. The authors facilitated the reflective process, and the participants worked in interprofessional, small groups.

What were the results?
The authors identified two overriding themes through their content analysis. The first was that clinician educators in the study were oriented toward the students' understanding of the reasoning process. And the second was that the educators had a heightened awareness of personal teaching styles and approaches to teaching clinical reasoning.

What are the implications of these findings?
Although the authors point-out several limitations of their study, they do provide a framework for helping clinical educators to explicitly define their critical thinking processes and to reflect on the way that they teach these skills to students. Furthermore, the "action research" method of "developing, trialing, evaluating, and refining" illustrates that we can apply quality improvement tools (i.e., Rapid PDSA Cycles) to our clinical teaching.

Editor's note: This study attempts to delve into the mind of the "unconsciously competent" clinician, and in so doing shows us how to be "consciously competent" (SLB).

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