How to … Coach Problem Representation to Strengthen Diagnostic Reasoning in Trainees

Problem representation (PR) is a concise synthesis of clinical information that captures the core diagnostic problem in a single statement, often referred to as a 'one-liner'. Although central to diagnostic reasoning, this skill is frequently underdeveloped in medical training. Many trainees struggle to transform clinical data into meaningful representations, which can hinder communication, diagnostic reasoning and patient safety. The Assessment of Reasoning Tool-Reconstructed (ART-R) provides a structured framework that educators can adapt as a coaching rubric to strengthen PR during clinical teaching. Using the ART-R, faculty can guide trainees to refine their PR by focusing on three elements: (1) clarity of the synthesized clinical problem; (2) emphasis on diagnostically relevant positive and negative findings; (3) use of precise medical terminology. This micro-coaching approach can be naturally embedded into clinical rounds through brief prompts that encourage trainees to refine their one-liner summaries. Through repeated practice, trainees develop increasingly abstracted representations that activate illness scripts and support diagnostic hypothesis generation. Coaching PR in this way provides a practical, low-burden strategy for strengthening diagnostic reasoning during routine clinical teaching. Integrating this approach into patient presentations can help educators cultivate stronger diagnostic reasoning.