Clinical Reasoning as a Core Competency

Connor, Denise M.; Durning, Steven J.; Rencic, Joseph J.

doi:10.1097/acm.0000000000003027

Cited by 96Clinical Reasoning and Diagnostic SkillsInnovations in Medical EducationArtificial Intelligence in Healthcare and Education

Clinical Reasoning as a Core Competency

Connor, Denise M., Durning, Steven J., Rencic, Joseph J.·2020·Academic Medicine

DOI 10.1097/acm.0000000000003027

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Abstract

Diagnostic error is a challenging problem; addressing it effectively will require innovation across multiple domains of health care, including medical education. Diagnostic errors often relate to problems with clinical reasoning, which involves the cognitive and relational steps up to and including establishing a diagnostic and therapeutic plan with a patient. However, despite a call from the National Academies of Sciences for medical educators to improve the teaching and assessment of clinical reasoning, the creation of explicit, theory-informed clinical reasoning curricula, faculty development resources, and assessment tools has proceeded slowly in both undergraduate and graduate medical education. To accelerate the development of this critical element of health professions education and to promote needed research and innovation in clinical reasoning education, the Accreditation Council for Graduate Medical Education (ACGME) should revise its core competencies to include clinical reasoning. The core competencies have proven to be an effective means of expanding educational innovation across the United States and ensuring buy-in across a diverse array of institutions and disciplines. Reformulating the ACGME core competencies to include clinical reasoning would spark much-needed educational innovation and scholarship in graduate medical education, as well as collaboration across institutions in this vital aspect of physicianship, and ultimately, could contribute to a reduction of patient suffering by better preparing trainees to build individual, team-based, and system-based tools to monitor for and avoid diagnostic error.

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Strengthening clinical reasoning is crucial for reducing diagnostic errors and improving timely diagnoses.
“Strengthening CR is crucial for reducing diagnostic errors and improving timely diagnoses. 7”
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Developing clinical reasoning competence is essential for optimizing patient-centered care.
“This is an important finding, as developing clinical reasoning competence is essential for optimizing patient-centered care [34].”
From Generative artificial intelligence in physiotherapy education: great potential amidst challenges- a qualitative interview study (2025) · cites this paper as [34]
These approaches share a focus on authentic problem-solving, hypothesis generation, and critical analysis of knowledge gaps-skills essential for both academic and clinical reasoning.
“These approaches share a focus on authentic problem-solving, hypothesis generation, and critical analysis of knowledge gaps7,16—skills essential for both academic and clinical reasoning.”
From Structured Development of Learning and Assessment Tasks to Prevent Generative AI Misuse and Enhance AI Literacy in the Faculty in Physiotherapy Education (2025) · cites this paper as [7]
Brainstorming and problem-solving are central in PBL and are also key components of clinical reasoning.
“This is particularly noteworthy, as brainstorming and problem-solving are central in PBL 25 and are also key components of clinical reasoning. 7”
From Structured Development of Learning and Assessment Tasks to Prevent Generative AI Misuse and Enhance AI Literacy in the Faculty in Physiotherapy Education (2025) · cites this paper as [7]

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Self-citation

Authors: Connor, D. M., Durning, S. J., & Rencic, J. J.
Affiliations: San Francisco VA Medical Center (US)
United States Department of Veterans Affairs (US)
Tufts University (US)
Corresponding author: Connor, Denise M.
ORCID: Connor, Denise M.
Durning, Steven J.
Rencic, Joseph J.
Venue: Academic Medicine
Publisher: Oxford University Press (OUP)
Published: 2019-01-10
Volume: 95
Issue: 8
Pages: 1166-1171
ISSN: 1040-2446 (ISSN-L)
DOI: 10.1097/acm.0000000000003027
OpenAlex: W2977391421
Cited by: 96
References: 33
Citations by year: 2026: 21 · 2025: 23 · 2024: 17 · 2023: 15 · 2022: 11 · 2021: 6 · 2020: 3
FWCI: 5.18
Type: journal article
Language: en
Open access: closed
Locations: Academic Medicine (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Innovations in Medical Education
Health Sciences › Medicine › Health Informatics › Artificial Intelligence in Healthcare and Education
Keywords: clinical reasoning, diagnostic errors, core competencies, Accreditation Council for Graduate Medical Education, graduate medical education, medical education reform, faculty development, assessment instruments, patient safety
MeSH terms: Clinical Decision-Making, Accreditation, Clinical Competence, Competency-Based Education, Diagnosis, Diagnostic Errors, Education, Medical, Humans

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Clinical Reasoning as a Core Competency

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