Negotiating the paradoxes of collaborative clinical reasoning: insights from a qualitative case study in longitudinal patient care

Abstract Background Collaborative clinical reasoning (CCR) may be defined as the process in which two or more healthcare team members negotiate diagnostic, therapeutic, or prognostic issues concerning an individual patient, resulting in an illness or treatment plan. CCR has become increasingly important in interprofessional healthcare and health professions education. Yet little is known about how healthcare professionals collectively construct clinical reasoning in authentic clinical settings, particularly within longitudinal patient care. This study aimed to explore how CCR is enacted within an interdisciplinary team, with particular attention to the processes and interactions through which professionals contribute to collective clinical reasoning. Methods We conducted an exploratory qualitative case study in an interprofessional paediatric outpatient centre in Geneva, Switzerland. Data consisted of video-recorded observations of an interdisciplinary case conference, followed by semi-structured stimulated recall interviews with six healthcare professionals. Data were analysed using a combined deductive and inductive thematic approach. Charlin et al.’s clinical reasoning framework informed the deductive analysis, while inductive analysis was used to identify dimensions of collaborative reasoning not adequately captured by this framework. Observational and interview data were treated as complementary but distinct sources, and preliminary findings were discussed with participants during a feedback session. Results Deductive analysis showed that participants could retrospectively identify the clinical reasoning processes described by Charlin et al., while direct observation provided more limited evidence that transitions between these processes were explicitly coordinated at team level. Inductive analysis identified three interrelated dimensions shaping CCR: organisational conditions, communication processes through which reasoning became visible and shareable, and professional identities and relational dynamics influencing collective sense-making. Information sharing did not necessarily entail reasoning sharing: collaborative reasoning became more accessible when observations, interpretations, hypotheses, and proposed actions were articulated, questioned, and reformulated. Leadership, hierarchy, and perceived interpersonal safety also shaped participation and the integration of complementary expertise. Conclusions Collaborative clinical reasoning extends beyond the integration of individual clinical expertise. Our findings suggest that CCR may be understood as a sociocognitive process shaped by organisational, communicative, and relational conditions. For health professions education, these findings highlight the importance of preparing learners and clinical teams not only to share information, but also to make their reasoning accessible to others, engage with alternative interpretations, and coordinate their progression through the clinical reasoning process. Educational approaches may also need to help teams recognise and navigate tensions between leadership and horizontality, psychological safety and cognitive challenge, and individual expertise and collective sense-making.