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INTRODUCTION

What exactly is reasoning?

Merriam-Webster defines reasoning as “the power of comprehending, inferring, or thinking, especially in orderly rational ways.”

If that’s reasoning, then what is clinical reasoning?

The definition for clinical reasoning is not so clear. In the literature, the definition often extends beyond a sentence to a paragraph or two.

Put simply, clinical reasoning involves the integration of knowledge and experience to reach a diagnosis or develop a treatment plan.

Clinical reasoning is a key factor in what distinguishes an electronic diagnostic tool from a human physician. Arriving at the correct diagnosis or treatment plan is not like a recipe, where symptoms are inputted and out pops an answer. Whether you are reading a patient presentation in a vignette or encountering a live patient, the sum is greater than its parts, and we need to rely on our ability to reason in order to arrive consistently at the correct conclusion.

One of my favorite quotes on this subject reads:

“While reasoning errors can coexist with medical knowledge problems, there exists a misconception that clinical reasoning errors are driven by a lack of medical knowledge rather than an inability to apply that knowledge in clinical practice.”1

The most common problem I see with my students is that they have a lot of medical knowledge but have no idea what to do with it. It is as though someone wrote every fact from First Aid down on various notecards and mixed them up in a bowl. Sometimes they could state a few correct facts, but even when they did, they had no idea how to apply them. And they had no idea how to learn to apply them.

I challenge my students to understand the pathophysiology behind every vignette or clinical scenario. And while it may feel as though you could memorize 50 Anki cards in the time it takes to understand the pathophysiology behind a single concept, I guarantee that your time will be better spent this way. Your understanding of pathophysiology will long outlast any facts you memorize.

When I used to study for exams in college, I relied heavily on memorization. I had stacks of hundreds of notecards in my backpack at all times. This worked great for courses like Biology or Genetics, where I had to memorize hundreds of facts and select the right answer from straightforward multiple-choice questions. But I never used notecards to study for my Physics or Calculus exams. Why? Because these courses rely on your ability to reason through complex problems. What good does memorizing a formula do if you don’t know how to apply it?

The following scenario is an example of how medical knowledge and application is much more like Physics than Biology.

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