In Search of a Unifying Theory: A Critical Typology of Clinical Reasoning in Health Professions Education

Abstract: Inquiries into the nature of clinical reasoning are as old as the practice of medicine itself. Yet the extraordinary advance of biomedical science and technology into the twenty-first century poses challenges to the concept of clinical reasoning that are at once unique to our time and layered with complexity. From the ongoing atomization of the practice of medicine into discrete specialties; to an ever-growing evidence-base for the biopsychosocial determinants of health and disease; to proliferating political economies of medical regulation, research, and quality management; and to the nascent deployment of generative artificial intelligence (AI) – clinical decision-making must now contend with a vast and variegated array of inputs and influences. Despite growing interest from accrediting institutions in establishing core competencies in clinical reasoning for students and trainees, no agreed-upon norms exist to guide such measurements. This paper supplies a critical typology of theories of clinical reasoning, examining the advantages and disadvantages each theory brings to decision-making in the real world of practice in the health professions. This work explores four major categories of clinical reasoning theory: dual process theory, narrative medicine, phronesis, and situated reasoning. Effective navigation of insights (and pitfalls) of these approaches can open up space for both constructive criticism between, and cross-fertilization across, seemingly disparate conceptions of decision-making.

Andrew Parsons, MD, MPH – Director of Clinical Competency, University of Virginia School of Medicine, University of Virginia School of Medicine