title: Teaching and learning clinical reasoning: tutors' perceptions of change in their own clinical practice.
abstract: BACKGROUND
  Clinical reasoning is an important skill for all clinicians and historically has rarely been formally taught either at undergraduate or postgraduate level. Clinical reasoning is taught as a formal course in the fourth year of the undergraduate programme at Keele School of Medicine by tutors who are all practicing general practitioners.
  
  
  OBJECTIVE
  We aimed to explore the tutors' perceptions about how teaching on the course has impacted on their own consultation skills.
  
  
  METHODS
  All 11 course tutors who had taught on the course for at least one full academic year were invited to take part in recorded individual semi-structured interviews with an experienced, non-clinical, qualitative researcher. The data were analysed using qualitative methods.
  
  
  RESULTS
  Eleven tutors participated, with a range of 7 to 32 years of clinical experience. They reported better decision-making, greater use of metacognition, more self-awareness, more reflective practice, more confidence and greater job satisfaction. They also reported positive impacts on their own knowledge and learning, and assumed concomitant benefits for their patients.
  
  
  CONCLUSIONS
  All clinicians in this group perceived benefits on their consultation skills as a result of teaching clinical reasoning. There is a need to provide education, training and continuing professional development in cognitive consultation skills to students, trainees and established practitioners.
authors.affiliation: Medical Education, Keele University School of Medicine, David Weatherall Building, Keele University, Keele, Staffordshire ST5 5BG, UK. m.h.bartlett@keele.ac.uk.
authors.forename: Maggie
authors.initials: M
authors.lastname: Bartlett
authors.affiliation: Keele University School of Medicine, UK.
authors.forename: Simon P
authors.initials: SP
authors.lastname: Gay
authors.affiliation: Keele University School of Medicine, UK.
authors.forename: Penelope Ad
authors.initials: PA
authors.lastname: List
authors.affiliation: Keele University School of Medicine, UK.
authors.forename: Robert K
authors.initials: RK
authors.lastname: McKinley
mesh_terms: D002983:Clinical Competence; D003479:Curriculum; D004501:Education, Medical / Q000379:methods*; D006801:Humans; D007858:Learning; D010465:Perception; D010820:Physicians / Q000523:psychology*; D013337:Students, Medical / Q000523:psychology; D013663:Teaching; D013850:Thinking