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Sam Leinster1 presents a very well-argued case for more generalists and describes clearly some of the barriers in the way of change. He states that ‘All doctors are taught general consultation and clinical reasoning skills’ but, while the first part is true, I wonder about the second. I am happy to be corrected, but my understanding is that only a minority of UK medical schools have curricula that incorporate formal teaching of clinical reasoning as we now understand it. Its inclusion in postgraduate training may not be much better.
Although there is still no consensus on a single best way to teach and learn the cognitive processes and errors that affect our decisions, there is growing recognition that effective clinical reasoning is vital for accurate and safe diagnosis and management.2 Strangely, the General Medical Council's key publication ‘Tomorrow's Doctors' makes no mention of clinical reasoning in its recommendations for education and training.3
Acquiring clinical reasoning skills early can help doctors to make the most of the, often limited, clinical experience available in relatively short training programmes. Arguably, it is skill in clinical reasoning that underpins generalist expertise although wide experience is also essential. It may be that some will choose a generalist role before becoming specialists and others will choose the opposite path; ensuring that clinical reasoning is taught properly to all medical students and doctors might help both groups.