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Best Practices, Real Limits: Teaching Clinical Reasoning in Busy Curricula

CLIME | Recorded March 13, 2026

Key Takeaways

In this Grand Rounds, Dr. Sandra Montero explored the complexity of teaching clinical reasoning and why it remains a persistent challenge in medical education. Drawing on decades of research and practical examples, she emphasized that clinical reasoning is not a single skill but a dynamic, context-dependent process shaped by experience, environment, and systems.

She introduced a simplified framework, immersion, integration, and intention to guide more effective teaching, highlighting the importance of experiential learning, connecting knowledge across domains, and making learning goals explicit for trainees.

Key insights

  • Clinical reasoning is complex, context-dependent, and cannot be reduced to a single skill or definition.
  • Teaching is challenging due to competing roles (clinician, educator, assessor) and system pressures.
  • Traditional curricula that separate knowledge (e.g., basic science vs. clinical practice) make learning harder for trainees.
  • Immersion in real or simulated clinical experiences is essential for developing reasoning skills.
  • Integrating basic science with clinical context improves learning, retention, and application.
  • Learners benefit from explicit guidance—clearly stating what they are expected to learn and why it matters.
  • Mistakes and feedback are critical components of learning, but must be thoughtfully supported.
  • Clinical reasoning is shaped not just by individuals, but by systems, environments, and social context.

    Sandra Monteiro, PhD

    Dr. Monteiro is an Associate Professor in the Department of Medicine’s Division of Education and Innovation and a MERIT Scientist in the Faculty of Health Sciences at McMaster University.

    She also serves as Director of Simulation Scholarship at the Centre for Simulation-Based Learning. Her early research challenged the belief that analytical thinking prevents diagnostic errors, demonstrating instead that increased thinking time sometimes introduces mistakes. She has since highlighted the limits of individual responsibility in error prevention, advocating for systemic approaches to support clinicians. Currently, she applies cognitive and behavioral science to examine how discrimination affects clinical reasoning, advancing equity in health professions education and healthcare.

    WATCH THE RECORDING

    Recorded on March 13 ,2026, Captions Available

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