Learning diagnostic reasoning: perceptions of trainees and supervisors in general practice.

Monday, September 14th, 2015

At Cyprus (Earli, 2015, August) Margje van de Wiel presented the first results of an interview study with GP-trainees and their supervisors about their perceptions of learning diagnostic reasoning. Her presentation was at a symposium entitled ‘Learning in and for the medical profession: from formal to informal and beyond’. (coauthors Christian Mengelers, Marjan Govaerts, Erik Stolper)


In the professional training of general practitioners, trainees work largely independently in diagnosing and treating patients. They mostly see patients alone and consult with their supervisors on a regular basis to discuss patients and problems, receive feedback, and improve on their diagnostic competence. Both the quality of care and the quality of training, thus, depend on the interactions between a supervisor and a trainee regarding diagnostic reasoning. In the present interview study, we examined how twelve experienced supervisors and their trainees perceived diagnostic reasoning and its learning process in general practice. We particularly focused on feedback processes and the role of gut feelings.

In line with research on workplace learning of residents and physicians, trainees thought that seeing patients and discussing cases with their supervisors were most valuable to learn diagnostic reasoning. Feelings of uncertainty and a sense of alarm were main reasons to discuss a case and ask for feedback and advice. The most valued supervisor role was to think along and ask questions to clarify trainees’ reasoning process. However, diagnostic reasoning was often not explicitly discussed. Both groups thought the process itself deserves more weight. Individual differences in approaches were substantial and if reflected upon they may learn from each other.

The study adds to our understanding of learning in medicine, and clearly showed that feedback processes were triggered by uncertainty and gut feelings. Interviewing both trainees and supervisors allowed us to compare their perceptions on learning diagnostic reasoning and to address these in their training.