# Clinical Reasoning: Perspectives of Expert Clinicians on Reasoning Through Complex Clinical Cases

## TL;DR

This study explores how expert clinicians approach complex medical cases, highlighting strategies that could improve medical training and reduce diagnostic errors.

## Contribution

The study identifies four key clinical reasoning strategies used by expert clinicians in handling complex cases.

## Key findings

- Expert clinicians prioritize connecting reasoning to patient context.
- They embrace uncertainty and work to reduce it systematically.
- Remaining humble and returning to the patient's bedside are emphasized to avoid diagnostic errors.

## Abstract

Introduction

Clinical reasoning is a core skill for physicians; most doctors do not attain the level of expertise associated with that of an expert clinician (EC). The purpose of this study is to identify the clinical reasoning strategies ECs prioritize when reasoning through complex cases.

Methods

We interviewed 14 ECs and performed a thematic analysis to identify strategies ECs prioritize when reasoning through complex clinical cases. The authors chose ECs based on the recognition of clinical and teaching expertise by trainees and other faculty members (ECs within our institution) and institutional recognition of high achievement in medicine and medical education (ECs outside our institution). We used a semi-structured guide to interview each EC, then reviewed and coded the interview transcriptions. We developed themes based on agreements between all transcript reviewers.

Results

We interviewed 11 male and three female ECs, one from outside the study institution. Two (14%) ECs were primary care physicians, and the remaining were sub-specialists. The authors organized strategies for clinical reasoning through complex cases around four themes, which were as follows: (1) connecting clinical reasoning to patient context; (2) embracing uncertainty, then reducing it; (3) returning to the patient’s bedside; and (4) remaining humble to limit diagnostic errors.

Conclusion

Clinical reasoning is a core clinical skill of physicians, and this article describes clinical reasoning strategies prioritized by ECs for complex clinical cases. Recognition and integration of these strategies into medical training and clinical educator practice may facilitate the evolution of clinical reasoning skills and reduce diagnostic errors.