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A Piece of My Mind
September 7, 2011

The Mechanics of Reasoning

Author Affiliations

Author Affiliation: Department of Medicine, University of California San Francisco and San Francisco VA Medical Center, San Francisco, California (

JAMA. 2011;306(9):918-919. doi:10.1001/jama.2011.1027

Students learn reasoning by listening to others reason. We teachers hope that clinical reasoning is on full display in clinics and wards, but frequently it is not. In the increasingly hectic clinical and educational environment, it is less common for the trainee to hear a more experienced clinician's distinct line of thought from the patient's first concern to conclusion. Moreover, since reasoning transpires largely at the subconscious level, it can be difficult for experienced physicians to slow down and unpack their internal dialogue. Students are left to pick up reasoning in bits and pieces and figure out their own way to “connect the dots” when faced with a patient.

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