Don't Just Model What You Do, Model How You Think

The expertise of medical and health professions educators is often invisible, or encapsulated, because it can become automatic. Pattern recognition, weighing evidence, and making complex decisions can be done with remarkable efficiency that benefits patient care but not necessarily the learner who needs to understand why decisions are made. By making your thinking and uncertainty visible and intentionally making space in your workflow to do so, everyday moments can be transformed into opportunities to develop learners with stronger clinical reasoning, tolerance for uncertainty, and adaptive expertise. 

Make Your Thinking Visible

Unless educators intentionally make their thinking visible, not just their decisions or actions, learners will observe expert decisions without understanding the cognitive or clinical reasoning behind them. Brief moments of narration can help educators share their thinking and turn routine patient care into powerful learning experiences. This is important not only in an experiential learning environment but also in the classroom with pre-planned teaching materials. When planning teaching moments and activities, intentionally build in time to broadcast your cognition. Learners will benefit from hearing:

• Why you chose something, for example, one diagnosis or management plan over another
• Why you rejected alternatives, for example, a diagnosis you ruled out  
• How you prioritized evidence, for example, how the clinical findings informed your decision 

Make Your Uncertainty Visible

Uncertainty is not a weakness and like your thinking, should not be hidden. Normalize it by creating opportunities to recognize, discuss, and manage uncertainty with learners. This demonstrates an ability to make probabilistic clinical decisions despite incomplete information and trains students on the iterative process of hypothesis generation, testing, and revision. Brief comments such as “Based on what we know, I am about 70% confident…,” can normalize knowledge limitations, intellectual humility, and good clinical judgement versus indecision. 

In addition to modeling uncertainty, purposefully integrating one or more of the below educational uncertainty stimuli into your teaching can help train learners to better tolerate uncertainty in their future practice:

• Challenge preconceptions via reflective prompts, challenging scenarios, or “grey” cases
• Forecast uncertainty by highlighting where ambiguity will present in future clinical contexts
• Place learners in unfamiliar environments to afford them an opportunity to experience and practice managing uncertainty

Make Space for Thinking

Medical and health professions educators balance competing demands every day, from providing patient care and supervising learners to conducting scholarship, serving their institution and communities, and sustaining a high level of teaching and student support. As these responsibilities accumulate, educators often experience substantial cognitive load. An unintended consequence is that, to gain efficiency, teaching may become streamlined and less transparent. It is therefore vital to intentionally make space for making your thinking and uncertainty visible. The goal is not to add more to your schedule but to create small moments where teaching can occur. Strategies to create cognitive space include: 

• Build short reflective moments into your workflow
• Summarize an important reasoning step before providing an answer
• Limit teaching pearls to one or two to enhance retention
• Share observations in the moment and feedback later 

MedEdPearls are developed monthly by the health professions educator developers in educational affairs. Previous MedEdPearls explored strengthening educator and learner relationships, elevating emotional intelligence, and navigating assumptions in feedback conversations.