Assessment of management reasoning: Design considerations drawn from analysis of simulated outpatient encounters

David A. Cook*, Steven J. Durning, Christopher R. Stephenson, Larry D. Gruppen, Matt Lineberry

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Purpose: Management reasoning is a distinct subset of clinical reasoning. We sought to explore features to be considered when designing assessments of management reasoning. Methods: This is a hybrid empirical research study, narrative review, and expert perspective. In 2021, we reviewed and discussed 10 videos of simulated (staged) physician-patient encounters, actively seeking actions that offered insights into assessment of management reasoning. We analyzed our own observations in conjunction with literature on clinical reasoning assessment, using a constant comparative qualitative approach. Results: Distinguishing features of management reasoning that will influence its assessment include management scripts, shared decision-making, process knowledge, illness-specific knowledge, and tailoring of the encounter and management plan. Performance domains that merit special consideration include communication, integration of patient preferences, adherence to the management script, and prognostication. Additional facets of encounter variation include the clinical problem, clinical and nonclinical patient characteristics (including preferences, values, and resources), team/system characteristics, and encounter features. We cataloged several relevant assessment approaches including written/computer-based, simulation-based, and workplace-based modalities, and a variety of novel response formats. Conclusions: Assessment of management reasoning could be improved with attention to the performance domains, facets of variation, and variety of approaches herein identified.

Original languageEnglish
JournalMedical Teacher
StateAccepted/In press - 2024
Externally publishedYes


  • Diagnostic reasoning
  • clinical decision-making
  • diagnostic errors
  • education, medical
  • reproducibility of results
  • therapeutic reasoning
  • validation studies as topic


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