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Using Functional Magnetic Resonance Imaging to Improve How We Understand, Teach, and Assess Clinical Reasoning


  • Steven J. Durning MD, PhD,

    Corresponding author
    • Correspondence: Steven J. Durning, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda MD 20814-4799; e-mail:

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  • Michelle Costanzo PhD,

  • Anthony R. Artino Jr PhD,

  • Cees van der Vleuten PhD,

  • Thomas J. Beckman MD,

  • Eric Holmboe MD,

  • Michael J. Roy MD, MPH,

  • Lambert Schuwirth MD, PhD

  • Disclosures: The authors report this work was supported in part by an American Board of Internal Medicine Foundation grant. The views expressed herein are those of the authors and do not necessarily reflect the Department of Defense or other federal agencies.


Clinical reasoning is essential to the practice of medicine. There have been many advances in the understanding of clinical reasoning and its assessment, yet current approaches have a number of important limitations. Functional magnetic resonance imaging (fMRI) is promising because it permits investigators to directly view the neuroanatomical changes that occur with thinking. In this article, we briefly review current approaches to assessing clinical reasoning, discuss the emerging role and utility of fMRI in understanding clinical reasoning, and suggest directions for future research, continuing education, and practice.