Role of work experience in developing expertise in clinical reasoning among intern house officers

Introduction and objectives
The centrality of work experience in developing expertise in clinical reasoning has been well-demonstrated. The objective of this study was to explore how work experience influence the development of clinical reasoning among intern-house officers.
Methods
A qualitative study was conducted among intern house officers (IHOs) working in major clinical disciplines in North Colombo Teaching Hospital. In 18 interviews, we explored the perceptions of the role of work experience in developing clinical reasoning. Based on 48 doctor-patient consultations and follow-up interviews, we cross-analysed how they used work experience in clinical decision making. All interviews were transcribed and thematically analysed.

Results
According to the themes emerged, work experience helped reasoning process in multiple ways. It enriched and consolidated knowledge by transforming theoretical knowledge to workable knowledge. Development and elaboration of illness scripts, pattern recognition, exposure to medical error and subsequent adoption of remedial measures, orientation towards more patient-centered care were sequel of work experience expediting clinical reasoning. Furthermore, it included exposure to pain and distress of patients which fostered compassionate and caring attitudes among IHOs, which facilitated clinical reasoning. Not only internal factors, e.g. internal motivation, reflective practice, but also external factors, e.g. guidance, support and feedback from senior doctors, contributed to make work experience more effective and make IHOs confident in decision making.

Conclusion
Work experience drove workable knowledge, which was a key determinant of clinical reasoning. Its attribution to moral development has indirectly facilitated gaining expertise. However, internal and external triggers were instrumental in making work experience useful for clinical reasoning.