A five-function theory-informed instructional design model for developing clinical reasoning

Abstract

Clinical reasoning is an iterative, context-sensitive phenomenon. Its instruction and assessment require distinct forms of educational design. Existing reviews, consensus guidance, and longitudinal curricula provide substantial content and teaching strategies. Further specification is needed to coordinate conceptual preparation, expert modeling, scaffolded whole-case practice, feedback, adaptive fading, and transfer across learner development. We present CRAFT, a theory-informed instructional design model organized around five functions: Conceptualize and Frame, Reveal and Model Clinical Reasoning, Apply Through Scaffolded Practice, Feedback and Reflect, and Transfer Toward Independence. CRAFT provides a curricular architecture organized around proposed readiness gates, in which the five functions recur in progressively more demanding cycles as knowledge, contextual variation, uncertainty, learner responsibility, and assessment stakes increase while instructional support decreases. These gates are design criteria for local testing, not validated progression thresholds. We compare CRAFT directly with established instructional approaches and longitudinal clinical-reasoning curricula, define function-specific transition criteria, and formulate five testable propositions linking model components to mechanisms, proximal outcomes, clinical-reasoning performance, and transfer. A multilevel sepsis example illustrates how the same case family could be adapted for learners at different stages. No learner cohort data are reported; the example is an instructional design demonstration, and the evaluation plan is prospective. The model's feasibility, mechanisms, incremental value, and boundary conditions require empirical testing.