Teaching clinical reasoning in medical education: qualitative insights from educators at two UK universities

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BACKGROUND: Deficiencies in clinical reasoning are a major contributor to diagnostic error and patient harm globally. There is increasing recognition of the need for longitudinal, integrated clinical reasoning teaching within medical curricula. This qualitative study explored educators' understanding and perceptions of clinical reasoning at two UK medical schools with differing approaches to clinical reasoning education. METHODS: Semi-structured interviews were conducted with 15 final-year medical clerkship supervisors across the two institutions. Interviews explored their understanding of clinical reasoning, experiences with teaching clinical reasoning, and perspectives on curriculum design and faculty development. Reflexive thematic analysis was used to identify key themes. RESULTS: Educators described clinical reasoning as a complex cognitive operation. While they broadly shared an understanding of its core components, and its essential role in effective clinical decision making, their individual accounts revealed variations in scope and emphasis. Key themes included the need for longitudinally integrated curricula, explicit clinical reasoning instruction, structured faculty development, and challenges such as time constraints, institutional culture, and variable student engagement. CONCLUSION: The roles of a longitudinal and integrated curriculum design and faculty development in preparing educators to teach clinical reasoning were highlighted. These results are crucial for those considering new curriculum implementation, highlighting the need to design and introduce a focused faculty development programme for educators alongside the planned curriculum.

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