Cultivating Clinical Acumen Through Mindful Experience

We have probably all seen a senior clinician who just knows. They have that 6^th sense that allows them to navigate a difficult, complex patient case with ease. They just seem to do the right thing at the right time, whether it is making a diagnosis or balancing a complex treatment plan with several competing factors. They have clearly developed clinical acumen.

 I have often heard senior clinicians bemoan that their juniors do not have clinical acumen. However, I’ve rarely heard any of them explain what clinical acumen is, let alone how to acquire it. Some clinicians speak as if clinical acumen is something that we are just supposed to intuitively understand, without explicit guidance. I disagree.

In my experience with bedside teaching, I have found that teachers can cultivate clinical acumen in their trainees.   

What do we mean by clinical acumen? I think this definition will suffice: the ability to navigate a clinical situation effectively and efficiently. 

So how does a clinician learn to navigate a clinical situation effectively and efficiently?

By going through clinical experiences mindfully and actively try to learn from them.

When trainees go through our experiences mindfully, they learn faster and develop clinical acumen more quickly.  

How can they be mindful? One, simple way is to have trainees analyze recent, clinical experiences and then ask them questions such as:

• What might they have done differently?
• What could they do to make things go smoother next time?
• If a variable changed, how would they have managed the situation differently?

By answering questions like this, the trainees run thought experiments, mental simulations that allow them to test ideas and plan for future situations. The results of these thought experiments help them prepare for similar situations in the future. By encouraging trainees to analyze these experiences in this way, we allow them to learn without having to be in every possible scenario. 

A trainee can do such an analysis themselves, and I encourage mine to do so. However, I tend to ask questions like the ones above during a patient presentation, when making decisions on patient care, and when debriefing after treating a patient. When the experience is more fresh, I find that there is better learning. When I have brought trainees through this process often and consistently, they start developing navigating clinical situations well very quickly. With these kinds of teaching processes, I have seen even very junior trainees start to develop acumen in just a few short weeks.

If you want to learn more about this and other clinical decision making processes, you can check out my book: A Guide to Clinical Decision Making