What is the evidence for effective teaching of clinical reasoning in pre-registration dentistry?

a commentary onThe impact of different teaching methods on clinical reasoning and clinical decision-making of dentistry students: a systematic review. Journal of Dental Education, 2026, 90(1), pp.33-42

designThis systematic review examined evidence on educational interventions aimed at developing clinical reasoning and decision-making skills in undergraduate dental students. Searches of PubMed, MEDLINE (Ovid), Cochrane Library, and Scopus were conducted to 15 September 2023. Eighteen studies met the inclusion criteria for qualitative synthesis. Study designs included cross-sectional and case-control approaches. PRISMA guidance was followed, and a flow diagram was provided. CASE SELECTION: Eligible studies were English-language reports evaluating clinical reasoning or decision making in undergraduate dental students. Studies involving qualified dentists, other healthcare professions, all review types, and non-peer-reviewed or grey literature were excluded. DATA ANALYSIS: Two reviewers independently extracted data, resolving discrepancies by consensus. Methodological quality was assessed using the Quality Assessment Tool for Quantitative Studies.

resultsFrom 1118 records, 18 studies were included. Most studies originated from Asia, with limited representation from Europe. Topics spanned oral medicine, prosthodontics, restorative dentistry, and endodontics. Most studies were rated 'weak,' reflecting limitations in sampling methods, confounding, and outcome measurement. No meta-analysis was feasible; findings were synthesised narratively across the different educational approaches. The emerging evidence does however suggest that interactive, technology-enabled methods (such as virtual patients, AI-assisted modules, mobile applications, integrated curricula, and team-based learning) may enhance aspects of clinical reasoning and decision making compared with traditional lectures or small-group discussions. However, effects were inconsistent, typically based on proxy measures such as self-confidence ratings, diagnostic thinking inventories, or think-aloud assessments. Definitions of "traditional" versus "new" teaching methods were often unclear, as was the conceptual relationship between clinical reasoning and clinical decision making.

conclusionsThe review suggests that educational strategies grounded in psychosocial rather than solely biomedical frameworks may support the development of clinical reasoning and decision-making abilities in undergraduate dental students. The overall strength of evidence is limited by heterogeneity, small sample sizes, non-validated outcomes, and variable terminology. High-quality studies employing standardised, robust measures of clinical reasoning are needed to guide future curriculum development.