This chapter discusses clinical reasoning and its importance in healthcare education. It presents a clinical reasoning framework that incorporates analytical methods used across health professions. The framework includes acknowledging problems, gathering data, analyzing information, developing solutions, implementing decisions, and evaluating outcomes. Effective teaching requires facilitating student thinking through comprehensive knowledge and realistic scenarios. Developing students' clinical reasoning also depends on addressing learning styles, building confidence through experiences, and promoting self-reflection and discussion.

1. Chapter 5
Critical Reasoning:
Action-Focused Thinking

2. Critical Reasoning:
Action-Focused Thinking
• Clinical Reasoning Framework
• Types of Learners
• Conditions for Learning
• Potential Problems

3. Critical Reasoning:
Action-Focused Thinking
• Previously critical thinking
– Model doesn’t encourage the learner to think about
their thinking
• Critical reasoning
– Moving to a deeper level of thinking, so the learner
is thinking about what they are thinking
• Need of a model of what clinical reasoning is
and how to implement it across disciplines

4. Clinical Reasoning Framework
• Institute of Medicine (IOM) 2003
– “All health professionals should be educated
to deliver patient-centered care as members
of an interdisciplinary team, emphasizing
evidence-based practice, quality
improvement approaches, and informatics”

5. Clinical Reasoning Framework
• clinical judgment
– “an interpretation or conclusion about a
patient’s needs, concerns, or health
problems, and/or the decision to take action
(or not), use or modify standard
approaches, or improvise new ones as
deemed appropriate by the patient’s
response” (Tanner, 2006, p. 204).

6. Clinical Reasoning Framework
• clinical reasoning
– the ability of the health professions student
to use critical thinking skills in the practice
environment
– Includes clinical imagination and reflection
– critical thinking is a snapshot in time while
clinical reasoning can accommodate the
changing nature in the clinical settings

7. Clinical Reasoning Framework
• knowledge translation
– the means by which new knowledge is
organized, given meaning or understood,
and is put in to action (Leahey &
Svavarsdottir, 2009)

8. Clinical Reasoning Framework
• Teachers
– Must use different tools to promote clinical
reasoning in their students
• Nursing Process - Nursing
• SNAPPS – Medical Education
• ICF – Physical Therapy
• These promote students thinking through
various steps of the clinical reasoning
process

9. Clinical Reasoning Framework
• Clinical reasoning tool
– Acknowledge the clinical problem
– Gather data
– Analyze the information
– Develop solutions or plan, make a decision
– Implement the decision
– Evaluate the decision

10. Clinical Reasoning Framework
• Proposed model for clinical reasoning
– See Table 5-1
– Incorporates all analytical methods used by
educators in various health professions
– Teaching critical reasoning must be
purposeful, and both planned and
spontaneous

11. Types of Learners
• Teaching clinical reasoning varies in style and
depth depending on where the student is in the
health professions program
• Students gravitate toward their dominant
learning styles
• Americans with Disabilities Act defines core
competencies with the intent of clarifying
minimal expectations for entry-level applicants
– E.g. Table 5-2

12. Types of Learners
• Essential attributes of learners that
contributes to the development of clinical
reasoning
– Motivation – a willing learner who desires to
become a health professional
– Attention to details – recognize and use vital
information in order to promote safe patient
outcomes
– Ability to formulate questions – for the
purposes of clarifying, acquiring, and
processing information

13. Types of Learners
• Essential attributes of learners that
contributes to the development of clinical
reasoning
– Awareness of knowledge gaps – can identify
what is not known and can identify
resources for narrowing the knowledge gap
– Awareness of own thinking – attention to
own strategies for thinking through a
problem and recognition of hindrances to
effective problem solving

14. Types of Learners
• Essential attributes of learners that
contributes to the development of clinical
reasoning
– Ability to draw analogies – taking known
information and applying to new situations
such as challenging patient example

15. Types of Learners
• Left-brain thinkers
– Verbal learners
– Process and absorb new knowledge through logic
and sequence
– Learn best through nursing process care plans
• Right-brain thinkers
– Absorb information visually, holistically and often
intuitively
– Prefer a more global approach – concept maps

16. Conditions for Learning
• Effective Teaching for Clinical Reasoning
• Student Considerations that Promote Clinical
Reasoning

17. Conditions for Learning
• Effective Teaching for Clinical Reasoning
– Comprehensive command of the subject
matter
– Facilitate the student's thinking rather than
just presenting information
– Current practice knowledge including
professional standards, guidelines, practice
recommendations and research evidence
– Use clinical practice background to provide
realistic clinical scenarios

18. Conditions for Learning
• Effective Teaching for Clinical Reasoning
– Use Socratic questioning
• What would we expect in the patient
when we see…?
• Leads students to start asking questions
• Teacher leads the student down a
particular path of thinking, redirecting
when necessary

19. Conditions for Learning
• Effective Teaching for Clinical Reasoning
– Use Socratic questioning
• See Figure 5-1
• Student clinical reasoning is not
enhanced when the faculty assumes
control of the situation
– Use reflective practice and self-analysis to
help decide where and how you want the
students to learn

20. Conditions for Learning
• Student Considerations that Promote Clinical
Reasoning
– Students must have strong self-concept in
order to trust their own judgment
– Low self-concept hinders initiating care
– Could project to the patient a lack of
competency

21. Conditions for Learning
• Student Considerations that Promote Clinical
Reasoning
– How to overcome lack of confidence
• Identify a simple hurdle that can be easily
overcome
• Talk a student through the steps
necessary prior to entering the room
• Role play with the student

22. Conditions for Learning
• Student Considerations that Promote Clinical
Reasoning
– The more clinical experiences the more
confident students become
– Opportunities to discuss clinical care
experiences allow students to validate
decisions and gain insight from peers
– Supportive instructor and staff make a big
difference

23. Potential Problems
• Student must be motivated to learn and apply
information in the academic and clinical arenas
– Studying and reading only the “required”
information does not provide all the information
needed.
– Core knowledge is essential to the professional field
– Using Socratic questioning, active discussion, and
case scenarios without a base knowledge will not
be enough to learn all that is needed to provide
adequate patient care

24. Potential Problems
• Students need to be successful in both the
didactic and practical portions of their learning
in order to be successful
• Must employ a continuous strategy that
assesses a student’s ability to transfer
theoretical knowledge to the clinical practice.

25. Conclusion
• Successful patient outcomes call for more than
critical thinking
• The proficient healthcare provider fuses
critical analysis with thoughtful, rational, and
reflective deliberations
• Teaching clinical reasoning calls for awareness
of how students learn and think, and thus
necessitates the use of a variety of teaching
strategies.