Examining Clinical Reasoning Through a Threshold Concept Lens

Importance: While there is an extensive body of evidence examining the learning of clinical reasoning in medicine, there is limited discussion of this in the context of musculoskeletal therapies. There is a need to better understand the complexity of clinical reasoning and to consider pedagogical approaches to support students to learn this troublesome skill. This commentary aims to (1) explore the complexity of clinical reasoning for the musculoskeletal therapies; (2) review clinical reasoning for musculoskeletal therapies through the lens of Threshold Concepts; and (3) explore approaches to curriculum and pedagogy to address the troublesome nature of learning to clinically reason. Observations: Beyond the established cognitive and metacognitive processes occurring as part of clinical reasoning, there are several factors that contribute to the complexity of this skill and make the learning and mastering clinical reasoning a challenge. Clinical reasoning has been identified as a threshold concept, in adjacent disciplines. The learning of clinical reasoning is troublesome, not least because of variability, issues with authenticity and integration of learning. Educators can assist students to navigate uncertainties faced when learning clinical reasoning. Conclusion and relevance: It is recommended that educators use an integrative pedagogical approach for developing the education of clinical reasoning in musculoskeletal therapies. Case based instruction and high-fidelity simulation may offer opportunities for students to develop adaptive expertise and self-regulatory reflective skills, improving their diagnostic and therapeutic reasoning. Approaching the education of clinical reasoning with the use of a threshold concept lens and integrative pedagogical approach, can assist students in learning the troublesome skill of clinical reasoning