Clinical reasoning. What is its nature? Can it be taught?

Clinical reasoning constitutes the core of medical practice, being the structural basis that defines the clinician as an expert. The common conviction--mostly among health care managers and politicians--that medicine is above all a scientific endeavor, and therefore all clinical decisions must be based exclusively on scientific evidence, is limited and does not take into account the inescapable need for clinical judgement in all its practical facets. The old saying "medicine is an art as well as a science" emphasizes the need to integrate the methodology of evidence-based medicine (EBM) with the methodology of the arts and humanities, seeking a medical praxis that satisfies patients as well as doctors. Clinical reasoning, as a crucial tool for medical practice, should be the subject of ongoing learning during medical school, post-graduation and continuing medical education. The teaching of clinical reasoning--in diagnosis, therapeutics and prognosis--requires from teachers an understanding of its two main aspects: its intrinsic nature and its development from novice to expert. This article discusses the nature of clinical reasoning, its evolution from student to medical specialist and its practical teaching.