The recent article titled "Teaching and Assessing Clinical Reasoning Skills" is the need of the hour, and is in the best interest of medical training [1]. Though the authors have extensively described about the Dual processing theory to improve the clinical reasoning of clinicians, teaching the same from the initial years of medical training may fetch the goal more effectively; the following discussion will further strengthen the above concepts [2].

Though many factors discussed pertain to poor clinical reasoning and lack of clinical skills, one important concern is the inadequate knowledge and understanding of the basic anatomy and physiology of an organ with relevance to a case scenario by the student. Since the medical subject is vast unless the basics are repeatedly taught in a similar style it will not get registered in the minds of the young doctors (e.g. instead of human heart being depicted with various illustrations over the years, a simple typical diagram can be followed from the beginning). If basics are forgotten, effective clinical problem solving is too difficult to practice in later years.

Since there is a gross mismatch between the perspectives of the educator and the student, didactic lectures can be curtailed, and each student may be exposed to the variety of clinical cases during the training. The clinical training should include both common and rare cases. Clinical examinations based on "Long case" alone may not improve the clinical reasoning skills. Clinical problem solving exercises serve as a good model to improve the clinical skills of the student. The analytical approach and the interactive discussion will enhance the skills of both the faculty and the student if both of them are unaware of the diagnosis. The interactive discussions between the educator, postgraduates and undergraduates during the grand rounds will improve the clinical skills of the students since the cases are presented randomly without prior exercise. Such grand rounds should be encouraged in all the medical institutions, so that a student can be given an opportunity to improve the reasoning skills from the early years of medical training [3].

The authors have mentioned multiple methods to evaluate the student during the final examination but all these should be practiced in a programmed manner from the early years of medical training to enhance clinical reasoning skills [4].

1. Modi JN, Anshu, Gupta P, Singh T. Teaching and Assessing clinical reasoning skills. Indian Pediatr. 2015;52:787-94.

2. Croskerry P. The theory and practice of clinical decision making. Can J Anesth. 2005;52:R1-8.

3. Kassirer JP. Teaching clinical reasoning: case-based and coached. Acad Med. 2010;85:1118-24.