Clinical reasoning as a threshold skill

AbstractBackground: Threshold skills are defined as new ways of thinking about and performing in a discipline. They represent transformed ways of thinking and doing that are pivotal to learners’ progress. Our aim was to establish whether clinical reasoning exhibited features of a threshold skill.Methods: Twenty-five final-year medical students were interviewed with a five-question protocol about how they were learning clinical reasoning. Students’ responses were analyzed using a deductive method to identify features of threshold skills.Results: Students’ descriptions of learning clinical reasoning exhibited five features: transformation, troublesomeness, integration, association with practice, and issues with transferability.Conclusions: Viewing clinical reasoning as a threshold skill is a novel interpretation of its nature and has implications for learning, teaching, and research. Students can be reassured that, although initially troublesome, with practice, they will not only learn the skill but also ho...