10 tips for clinical educators in designing and delivering learning experiences to improve clinical reasoning for medical students.

Background: Clinical reasoning processes involve gathering and interpreting information, creating differential diagnoses and testing hypotheses to inform and guide patient management. Effective clinical reasoning is an essential graduate outcome for medical students to ensure safe and efficient care of patients. In the clinical setting, a large proportion of hospital-related adverse events are attributed to errors in cognitive processes rather than knowledge, including diagnostic reasoning and decision-making. Teaching clinical reasoning is challenging due to its implicit nature, typically relying on internal thinking processes, pattern recognition and the use of prior clinical experiences. Current conventional teaching relies on student-driven application of clinical reasoning during their rotations as part of a hidden curriculum, which can be highly variable, unstructured, non-standardised, with limited oversight from faculty and with few opportunities for feedback. Furthermore, current barriers exist, including difficulties in teaching and assessing clinical reasoning. Due to this, many educators and faculty agree upon the significance of embedding explicit teaching and assessment of clinical reasoning into the curriculum, however the best approach remains poorly characterised. Methods: A narrative synthesis was undertaken from the current literature and the authors' collective experience. The synthesis distils this information into ten practical tips to guide design, integration and innovation of clinical reasoning teaching in medical education. Results: Ten tips were identified to support educators' efforts in embedding clinical reasoning into curriculum design and teaching. Together, these ten tips promote explicit, reflective and contextual clinical reasoning learning within the contemporary medical curriculum. Conclusions: Clinical reasoning requires deliberate, longitudinal and student-centred approaches that are integrated within authentic situated learning experiences. The ten tips provide avenues for more evidence-based adoption of effective learning environments that focus on clinical reasoning skills development.