Once the purview of the research community, clinical reasoning concepts are increasingly used to inform how teachers teach and learners learn.1 This welcome development has been signaled by the widespread use of clinical reasoning terminology in teaching sessions, conferences, and general medical publications. Technical terminology arises in any community where foundational units of knowledge (eg, terabyte or osmosis) are necessary for members to communicate with precision and brevity.2 For interdisciplinary fields like clinical reasoning, terminology evolves iteratively as multiple groups think about a problem independently, develop knowledge and language simultaneously, and then use these terms to communicate between groups.3 Given this evolutionary process, it is helpful to periodically examine the state of terminology and its utility to the members of a community. In this issue of the Journal of Graduate Medical Education, Musgrove et al4 compared the frequency of clinical reasoning terms in 79 published clinical problem solving exercises to a ranking of clinical reasoning concepts by a group of educators at a single academic center. They found that educators prioritized some of the same concepts that were featured prominently in published exercises (eg, problem representation, illness script, and dual process thinking), but that published exercises placed greater emphasis on such concepts as bias and context specificity. Given the different goals of clinical instruction and case reports, this discrepancy is not surprising. Teachers often frame their instruction around undifferentiated patients in ways that put reasoning front and center in order to stimulate the triggering and sorting of common diagnoses. In contrast, published cases prioritize the retrospective review of an engaging dilemma, often resolved by an unusual diagnosis. Clinical reasoning is at the core of the reader's journey, but whether the case illustrates a specific clinical reasoning concept is often an afterthought. The analysis by Musgrove et al4 raises many interesting questions about these terms and their usage, but front line educators should consider this fundamental question: Is learning clinical reasoning lingo useful for teachers or their trainees?;Teachers Every medical educator teaches clinical reasoning. Whenever knowledge is broadcasted, it has the potential to be incorporated by the learner and applied to a future patient encounter. This learning transfer depends on multiple factors, including learner motivation,5 previous exposure to content,6 cognitive load,7 and emotional valence of the content.8 Instructors can deliberately craft their teaching so that improved reasoning is an intentional goal and not just a fortuitous by-product. But to do so consistently they need to understand clinical reasoning concepts. The main debate around teaching clinical reasoning is whether the instructor should aim to shape learners' knowledge structures or aim to shape learners' thought processes. Discussion continues regarding the merits and pitfalls of each approach.9,10 Teachers who focus on the development of long-term memory structures pay close attention to how knowledge is scripted in the brain.11 They aim to enhance knowledge through mixed practice12 (eg, “I will assign you 3 different headache cases during the coming week in clinic”) and repetition with real world cases.13 They insist on refined assessments (eg, “Can you summarize the key aspects of this case in 1 sentence?”) because of the central role of problem representations in script activation. They ask questions that force the learner to compare and contrast illness scripts (eg, “Why is this venous stasis and not cellulitis?”). These teachers do not have to articulate script-related terms during instruction to achieve the desired results, but a theoretical foundation helps to organize a consistent teaching approach.14 Teachers who focus on thought processes aim to calibrate trainees' mode
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机译：一旦研究界的职权范围，临床推理概念越来越多地用于了解教师教学和学习者的学习方式.1这种欢迎的发展已经通过临床推理术语，会议和一般医学出版物的临床推理术语广泛使用。技术术语在任何社区中出现的任何社区（例如，Terabyte或渗透）是成员与精确和简洁的必要条件，因为对于临床推理等跨学科领域，术语迭代地发展，因为多个群体独立地考虑问题，开发同时知识和语言，然后使用这些术语在组之间进行沟通，3给出了这种进化过程，有助于定期检查社区成员的术语及其公用事业。在这个问题中，Musgrove等问题，比较了79名发表临床推理术语的临床推理术语频率，在一个学术中心的一组教育工作者对临床推理概念的排名进行练习。他们发现教育工作者优先考虑出版的练习中突出的一些相同的概念（例如，问题表示，疾病剧本和双重进程思考），但发表的练习更加强调这类概念作为偏见和背景特异性。鉴于临床教学和案例报告的不同目标，这种差异并不令人惊讶。教师经常以施加推理前沿和中心的方式在未分化的患者周围绘制他们的指示，以刺激常见诊断的触发和分类。相比之下，公布案例优先考虑了对接合困境的回顾性审查，通常通过异常诊断来解决。临床推理是读者旅程的核心，但案例是否说明了特定的临床推理概念往往是事后的概念。 Musgrove et al4的分析提出了许多关于这些条款及其用法的有趣问题，但前线教育者应该考虑这一基本问题：学习临床推理Lingo对教师或其学员有用吗？;教师每位医学家都教授临床推理。每当广播知识时，它有可能被学习者合并并应用于未来的患者遇到。这种学习转移取决于多个因素，包括学习者动机，5之前的内容暴露，6个认知负载，7个认知负荷，7和情绪化价值的内容。副产品。但要始终如一，他们需要了解临床推理概念。关于教学临床推理的主要辩论是教师是否应旨在塑造学习者的知识结构或旨在塑造学习者的思维过程。讨论继续有关每种方法的优点和陷阱.9,110教师专注于长期记忆结构的发展，密切关注知识在大脑中的脚本.11他们旨在通过混合实践来提高知识（例如， “我会在诊所到来的一周内为您分配3个不同的头痛案例”）和与现实世界案例的重复.13他们坚持提炼评估（例如，“你可以在1句中总结这种情况的关键方面吗？”）因为问题表示在脚本激活中的核心作用。他们提出了强迫学习者比较和造影疾病脚本（例如，“为什么这种静脉曲张而不是蜂窝织炎的问题？”）。这些教师不必在教学中表达与脚本相关的术语来实现所需的结果，但理论基础有助于组织一致的教学方法.14专注于思想流程的教师旨在校准学员的模式
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