Improving Clinical Decision-Making through Education and Reasoning

Clinicians make complex decisions every day. In high-stake, rapidly changing environments where each decision can significantly impact patient outcomes, it’s important for clinicians to pause, reflect, and make thoughtful choices amid the pressure.

Emily Abdoler, MD, MAEd, clinical educator and educational researcher in the Division of Infectious Diseases, is looking at ways to improve the future of clinical decision-making and the diagnostic process through clinical reasoning, reflective practice, curriculum development, and medical education. See how her work is helping shape the next generation of infectious diseases clinicians into adaptive, diagnostic thinkers.

Building Thoughtful Habits for Clinical Decision-Making

As an educational researcher, Dr. Abdoler’s qualitative research focuses on metacognition, which includes both clinical reasoning and reflective and deliberate practice, or how clinicians make decisions. “I don’t think these processes are inherently complex,” says Dr. Abdoler. “We’re thinking all the time. In fact, cognitive psychology has provided a lot of the basis around these theories, so I think of explaining it in a way to help learners create a framework for understanding the pathophysiology they have to learn in their training.”

Like many areas of medical education, teaching these complex topics comes with its challenges. Early learners must balance the heavy volume of preclinical learning and limited exposure they get, while beginning to develop clinical thinking in a largely classroom-based environment. Meanwhile, more advanced learners are adjusting to the demands of the clinical phase, like balancing service and education, while trying to find time in their busy clinical day to have these educational interactions. “These experiences in the clinical realm are so varied and sometimes unpredictable, which is good because that’s how people learn,” says Dr. Abdoler, “but it can be a challenge to find the time to have meaningful conversations about these topics.”

A crucial component of effective clinical decision-making in a high-pressure environment, is having the ability to slow down, reflect, and engage in thoughtful discussions with fellow clinicians about patient cases. These collaborative interactions play a key role in supporting accurate diagnostic and treatment decisions—benefiting both clinicians and their patients. “One of the most valuable aspects of academic medicine is the built-in sense of teamwork,” says Dr. Abdoler. “Whether it’s during Grand Rounds, team meetings, or clinical precepting, there’s always someone you can turn to. Even the colleague sitting next to you, working on a completely different case, can offer a fresh perspective or be a sounding board for your ideas.”

While some clinical situations require immediate action, most of the time there is an opportunity for clinicians to pause and consider potential gaps in knowledge, biases that might come into play, and other important factors. It’s essential for learners to develop habits of thinking about how they’re working through a case, talking it through with others, verbalizing their reasoning, and asking others to verbalize their reasoning to them. Over time these habits become second nature, helping learners think, consider, and reflect at different points of the diagnostic process.

Cultivating Reflective Clinicians Across GME

For years, Dr. Abdoler has led a reflective practice curriculum for the infectious diseases fellows in the division. Dr. Abdoler started the program as an advanced fellow, with her co-fellows and faculty, at another institution and then expanded it when she came to the University of Michigan. Slowly, it developed into a longitudinal curriculum on how to build practices of habit around reflection in clinical practice. 

This work laid the foundation for Dr. Abdoler’s selection in the 2025 class of the National Academy of Medicine (NAM) Scholars in Diagnostic Excellence Program. The class includes scholars from a diverse array of institutions and backgrounds, bringing unique approaches to diagnostic excellence. “Coming at this very large, complex issue from different ways, I think I have so much to learn,” says Dr. Abdoler. “The program supports a project, but more importantly, supports a person. I’m excited for the opportunity to work with new mentors and learn different ways of thinking about this issue that go beyond the lens I’ve taken.” 

As part of the one-year, part-time NAM program, scholars will develop effective strategies to raise awareness about diagnosis in medicine, support diagnostic excellence, and reduce diagnostic errors at a national level. Dr. Abdoler’s project, “REFLECT: Reflective Exercises for Learning Diagnosis While Engaged in Clinical Training,” will expand on her current reflective practice curriculum to those across internal medicine general medical education (GME), residents, and subspecialty fellows. The project will cover a series of topics on reflective practice and diagnostic thinking, followed by a workshop to explore which strategies proved effective and why.

Through this project, Dr. Abdoler hopes to share a more thoughtful approach to diagnostics in infectious diseases and beyond. As access to big data, artificial intelligence, and performance metrics increases, there is growing potential to improve diagnostic accuracy. However, there still needs to be thought into what the data means and how clinicians can incorporate these insights into their practice. In the rapidly evolving GME environment, Dr. Abdoler’s project, and the Scholars in Diagnostic Excellence Program overall, encourages trainees to stay engaged, adaptable, and grounded in continued learning. 

The Diagnostic Process: Present and Future

Clinical decision-making, and the cognitive processes that drive it, has become a far more prominent topic in medicine than it once was. It has integrated into the clinical system, requiring clinicians to understand how to navigate it and overcome the barriers. “There’s so much involved in the diagnostic process,” says Dr. Abdoler. “There are major impacts from the system, people, and circumstances of individual patients that we need to attend to a little more.”

In infectious diseases, the future of the diagnostic process and clinical decision making is full of opportunity. With increasing access to information and available tools, clinicians are better positioned to understand and improve their practice “We’re really poised to have access to information that can help us better understand our practice and become more adaptive, lifelong learners,” says Dr. Abdoler. “I’m excited to think about a generation of providers where this becomes routine, and they are constantly striving for additional development of expertise in their practice to the benefit of patients and systems as a whole.” 

Dr. Abdoler’s work highlights the role of reflection and reasoning in clinical education. By helping trainees develop the skills to pause, assess, and think critically, Dr. Abdoler is fostering a culture of thoughtful decision-making in infectious diseases. 

Learn more about Dr. Abdoler’s research.