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Open Access Highly Accessed Research article

Teaching clinical reasoning by making thinking visible: an action research project with allied health clinical educators

Clare Delany12* and Clinton Golding34

Author Affiliations

1 School of Health Sciences, The University of Melbourne, Melbourne, Australia

2 Children’s Bioethics Centre, at the Royal Children’s Hospital, Melbourne, Australia

3 Higher Education Development Centre, University of Otago, North Dunedin, New Zealand

4 Honorary Senior Fellow of the Centre for Higher Education, University of Melbourne, Melbourne, Australia

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BMC Medical Education 2014, 14:20  doi:10.1186/1472-6920-14-20

Published: 30 January 2014



Clinical reasoning is fundamental to all forms of professional health practice, however it is also difficult to teach and learn because it is complex, tacit, and effectively invisible for students. In this paper we present an approach for teaching clinical reasoning based on making expert thinking visible and accessible to students.


Twenty-one experienced allied health clinical educators from three tertiary Australian hospitals attended up to seven action research discussion sessions, where they developed a tentative heuristic of their own clinical reasoning, trialled it with students, evaluated if it helped their students to reason clinically, and then refined it so the heuristic was targeted to developing each student’s reasoning skills. Data included participants’ written descriptions of the thinking routines they developed and trialed with their students and the transcribed action research discussion sessions. Content analysis was used to summarise this data and categorise themes about teaching and learning clinical reasoning.


Two overriding themes emerged from participants’ reports about using the ‘making thinking visible approach’. The first was a specific focus by participating educators on students’ understanding of the reasoning process and the second was heightened awareness of personal teaching styles and approaches to teaching clinical reasoning.


We suggest that the making thinking visible approach has potential to assist educators to become more reflective about their clinical reasoning teaching and acts as a scaffold to assist them to articulate their own expert reasoning and for students to access and use.

Clinical reasoning; Diagnostic reasoning; Clinical education; Professional development; Action research