Fostering clinical reasoning in medical students.

摘要

Context and setting Diagnosis based on sound clinical reasoning lies at the heart of medical practice; consequently, medical schools focus on developing students' clinical reasoning in more or less explicit ways. The principal emphasis in the early undergraduate years is on learning and integrating basic and clinical sciences in order to understand disease processes and principles of treatment and management; at best, clinical reasoning is acquired as a serendipitous side-effect rather than being learned as an essential skill in its own right. Frequently, it is not until the final years of medical school, when students spend the majority of their time in direct contact with patients, that they begin to recognise the importance of clinical reasoning in the diagnostic process. Even then, diagnostic skill is often acquired more by a process of osmosis than actively within a broadly applicable framework.