Mapping the Social Interaction Architecture of Clinical Reasoning in Morning Report: A Mixed-Methods Social Network Analysis.

Introduction: Morning Report (MR) is a workplace-based learning activity in which clinical reasoning develops through interaction among learners and clinical teachers. Although previous studies have examined the educational value of MR, less is known about how clinical reasoning is socially constructed through patterns of communication and participation. This study aimed to investigate the interactional architecture of MR using Mixed-Methods Social Network Analysis (MMSNA). Methods: We conducted a qualitatively driven data transformation mixed-methods study using verbatim transcripts from 20 MR (Approximately 780 minutes) sessions across Internal Medicine, Cardiology, and Pediatrics from three 1000-bed hospitals in Iran. Qualitative content analysis was used to identify educational interaction patterns, which were subsequently converted into network matrices. Two complementary network structures were constructed and analyzed using centrality measures: (1) participant-to-participant interaction networks and (2) interaction-pattern transition networks. Results: The qualitative analysis identified ten educational interaction patterns, primarily involving case presentation, diagnostic questioning, responses, and teaching explanations. SNA revealed that educational roles, particularly those of facilitators and presenters, shaped network centrality more strongly than academic rank or gender. Specialty-specific differences in network structures were observed: Internal Medicine and Pediatrics demonstrated facilitator-centered networks, whereas Cardiology showed a presenter-centered configuration. Response and answer patterns emerged as important bridging elements that connected different phases of the discussion. Discussion: MMSNA provides a novel framework for examining how clinical reasoning emerges through social interaction by integrating the meaning of educational conversations with their relational organization. The findings highlight the importance of intentional facilitation strategies that promote effective questioning, learner engagement, psychological safety, and an appropriate balance between expert guidance and learner autonomy.