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A ‘think aloud’ exercise to develop self-awareness of clinical reasoning in students

02 August 2020
Volume 12 · Issue 8



This study aimed to evaluate the ‘think aloud’ teaching exercise's ability to develop clinical reasoning skills of student paramedics, and to ascertain its feasibility as an ongoing method to enhance clinical reasoning teaching and potentially alleviate problems around applying theoretical learning to practice.


A qualitative approach was taken to seek the opinions and experiences of students taking part in the activity to determine levels of enjoyment, how relatable it was to students, and awareness of the skills it was intended to develop. Data collected via an online survey tool were analysed to identify themes and comments.


Student enjoyment and engagement were evident, and the exercise permitted independence of thought and working, promoting self-appraisal among students of the effectiveness of the working strategy.


The results of this case study indicate that the think aloud exercise could be effective in developing students' clinical reasoning skills. It complements established teaching strategies, such as core lectures, seminars and supervised practice.

Clinical reasoning is a situated, practice-based form of reasoning requiring background scientific knowledge applied to a particular patient using the clinical evidence presented (Benner et al, 2008). It is an essential component of professional practice and enables health professionals to analyse information relevant to patient care. Modern healthcare involves complex decision-making processes, often under conditions of uncertainty (Simmons et al, 2003), so practitioners need strong clinical reasoning skills.

Patient safety is paramount to healthcare providers (Berwick, 2013); however, preventable harm affects nearly one in 20 patients within health services in the UK (Panagioti et al, 2017). In the 2017–2018 financial year, the NHS paid out more than £1.63 billion in damages to clinical negligence claimants (NHS Resolution, 2018). Improving clinical reasoning may strengthen professional practice by increasing the accuracy of decisions and therefore improve patient outcomes (Simmons et al, 2003).

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