• Meredith Young, Aliki Thomas, Stuart Lubarsky, Tiffany Ballard, David Gordon, Larry D Gruppen, Eric Holmboe, Temple Ratcliffe, Joseph Rencic, Lambert Schuwirth, and Steven J Durning.
• M. Young is assistant professor, Department of Medicine, and research scientist, Centre for Medical Education, Faculty of Medicine, McGill University, Montreal, Quebec, Canada. A. Thomas is assistant professor, School of Physical and Occupational Therapy, and research scientist, Centre for Medical Education, Faculty of Medicine, McGill University; and researcher, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, Quebec, Canada. S. Lubarsky is assistant professor, Department of Neurology, and core member, Centre for Medical Education, Faculty of Medicine, McGill University, Montreal, Quebec, Canada. T. Ballard is a plastic surgery resident, University of Michigan, Ann Arbor, Michigan. D. Gordon is associate professor, Division of Emergency Medicine, Department of Surgery, Duke University School of Medicine, Durham, North Carolina. L.D. Gruppen is professor, Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Michigan, United States. E. Holmboe is senior vice president for milestone evaluation and development, Accreditation Council for Graduate Medical Education, Chicago, Illinois, and adjunct professor of medicine, Yale University, New Haven, Connecticut, and Feinberg School of Medicine, Northwestern University, Chicago, Illinois. T. Ratcliffe is associate professor, Department of Medicine, University of Texas Health Science Center, San Antonio, Texas. J. Rencic is associate professor of medicine, Tufts University School of Medicine, and member, Division of General Internal Medicine, Tufts Medical Center, Boston, Massachusetts. L. Schuwirth is professor of medical education, Flinders University, and director, Flinders University Prideaux Centre for Research in Health Professions Education, Adelaide, South Australia, Australia; and professor of medical education, Maastricht University, Maastricht, the Netherlands; Chang Gung University, Taoyuan City, Taiwan; and Uniformed Services University of the Health Sciences, Bethesda, Maryland. S.J. Durning is professor of medicine and director of graduate programs in health professions education, Uniformed Services University of the Health Sciences, Bethesda, Maryland.
• Acad Med. 2018 Jul 1; 93 (7): 990-995.

AbstractClinical reasoning is an essential component of a health professional's practice. Yet clinical reasoning research has produced a notably fragmented body of literature. In this article, the authors describe the pause-and-reflect exercise they undertook during the execution of a synthesis of the literature on clinical reasoning in the health professions. Confronted with the challenge of establishing a shared understanding of the nature and relevant components of clinical reasoning, members of the review team paused to independently generate their own personal definitions and conceptualizations of the construct. Here, the authors describe the variability of definitions and conceptualizations of clinical reasoning present within their own team. Drawing on an analogy from mathematics, they hypothesize that the presence of differing "boundary conditions" could help explain individuals' differing conceptualizations of clinical reasoning and the fragmentation at play in the wider sphere of research on clinical reasoning. Specifically, boundary conditions refer to the practice of describing the conditions under which a given theory is expected to hold, or expected to have explanatory power. Given multiple theoretical frameworks, research methodologies, and assessment approaches contained within the clinical reasoning literature, different boundary conditions are likely at play. Open acknowledgment of different boundary conditions and explicit description of the conceptualization of clinical reasoning being adopted within a given study would improve research communication, support comprehensive approaches to teaching and assessing clinical reasoning, and perhaps encourage new collaborative partnerships among researchers who adopt different boundary conditions.

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