Emotions and Clinical Reasoning in Medical Education and Clinical Practice: A Scoping Review

PURPOSE: Clinical reasoning, an essential skill in medicine, is significantly influenced by emotions. Although the cognitive aspects of clinical reasoning have been extensively studied, the impact of emotions remains underexplored. This scoping review aimed to map the existing literature on the influence of emotions on clinical reasoning across medical education and practice.

METHOD: The authors conducted a scoping review (March 11, 2022, and December 1, 2023) following Arksey and O'Malley's framework of MEDLINE (Ovid), Embase (Elsevier), Web of Science, and PsycInfo (Ebsco) to identify relevant literature. All empirical studies examining the interplay of emotions and clinical reasoning on the continuum of medical education training were eligible for inclusion.

RESULTS: Sixty-one studies met the inclusion criteria. The findings indicate that negative and anxiety-provoking emotions, such as stress, fear, and uncertainty, are predominantly highlighted in the literature as influencing clinical reasoning. These emotions were associated with conservative clinical approaches, increased diagnostic errors, and suboptimal management decisions. Anxiogenic emotions showed mixed effects, sometimes leading to more thorough evaluations but also potentially prompting unnecessary interventions. Conversely, positive emotions and gut feelings, often cultivated through experience, were found to support effective clinical reasoning and potentially improve patient care by fostering adaptability and diagnostic accuracy.

CONCLUSIONS: This review captures the integral role of emotions in clinical reasoning, impacting every facet of patient care. The nuanced interplay between emotions-both positive and negative-and clinical reasoning emphasizes that emotions not only arise as byproducts of clinical encounters but actively shape clinical reasoning. These findings call for educational interventions that equip clinicians with emotional awareness and regulation strategies to enhance their clinical reasoning. Future research should explore the influence of positive emotions, investigate the effectiveness of emotional regulation interventions, and address gaps in understanding the contextual and cultural variability in emotional dimensions of clinical reasoning.