Supervision of clinical reasoning: methods and a tool to support and promote clinical reasoning.

Every day, clinician teachers witness the shock experienced by new residents when they realize that a clinic is in a constant state of uncertainty. Undifferentiated complaints, diagnostic doubts, the familial, social, and cultural characteristics of the patient and his or her perspective, and the working environment and its imponderables are among the factors that cause residents to “lose their innocence,” as Boshuizen puts it.2 In this context, the ability to make adequate decisions requires a reflexive practice and excellent clinical reasoning skills. For clinician teachers, supervising clinical reasoning offers both a formidable challenge and a unique opportunity to support and promote the development of these skills.