The Six R's of Management Reasoning for Subintern Education

Management reasoning (MR), the component of clinical reasoning concerned with treatment planning, patient preferences and resource considerations, develops later than diagnostic reasoning and remains underemphasised in medical education. Despite calls to explicitly teach MR, instructional strategies remain scarce.

We developed a mnemonic, the "Six R's of Management Reasoning," and implemented a 90-min workshop grounded in social constructivism. Between July 2023 and December 2024, we taught 22 sessions to 119 subinterns. Students used the mnemonic to collaboratively construct management plans and admission orders through case-based activities and facilitated discussions.

Using three levels of Kirkpatrick's model-reaction, learning and behaviour-we assessed the workshop through IRB-approved surveys, tests and workplace assessments. Postworkshop and postrotation surveys showed significant increases in students' confidence and ability to apply MR (all p < 0.001). Knowledge test scores improved from 81.7% to 93.3% (p < 0.001, Hedges's g = 1.20). Faculty assessments confirmed students' strengths in risk calculation and shared decision-making, though some students struggled with applying high-value care and citing evidence.

The "Six R's of Management Reasoning" provided a practical tool for MR development, and activities selected based on social constructivism were effective and well received. Mixed performance in clinical settings suggests that MR requires longitudinal reinforcement, repeated patient encounters and continued mentorship beyond a single workshop. This approach is feasible for broader implementation and may serve as a foundation for intentionally integrating MR across the medical education continuum.