How postgraduate medical trainees conceptualise management reasoning: A qualitative study

Area of Science:

• Medical Education
• Clinical Reasoning
• Healthcare Trainee Education

Background:

• Management reasoning (MR) is poorly understood in medical education.
• Current knowledge relies on theoretical models or limited studies of physicians.
• Little is known about how trainees conceptualize and apply MR in daily practice.

Purpose of the Study:

• To explore how postgraduate trainees conceptualize management reasoning (MR).
• To describe the process of MR as enacted by trainees.
• To identify contextual influences shaping trainee MR during medical training.

Main Methods:

• Qualitative study employing a constructivist paradigm and reflexive thematic analysis.
• Four semi-structured focus groups with 28 senior postgraduate trainees.
• Analysis of verbatim transcripts using inductive coding and iterative theme development.

Main Results:

• Trainees link MR to diagnostic reasoning but emphasize its pragmatic, action-oriented nature.
• MR is characterized by negotiation of uncertainty and risk, requiring flexibility.
• The MR process includes core components (working diagnosis, options, contextualization, follow-up) and variable, context-dependent elements.
• Various contextual factors significantly influence trainee MR.

Conclusions:

• Postgraduate trainees perceive MR as a dynamic, complex, and flexible process.
• The study highlights the patient-centered, context-dependent nature of MR, with a focus on uncertainty and risk from the trainee viewpoint.
• Enhancing visibility of MR in clinical practice is crucial for medical educators.