Residents As Teachers - TEACH Model - T = Think Out Loud


T = Think Out Loud

Clinical decision-making is one of the most important things you can teach medical students, especially in clinical settings.

However, medical students are often in the position of being aware of a patient’s medical problem and hearing about a decision made regarding a patient, but not necessarily understanding the process that led the clinician to making that decision.

You might ask a student what s/he would do in a given clinical scenario. They may identify a correct course of action, yet based only on that information, it is impossible for the instructor to know if the student merely guessed correctly, if the student used faulty logic but still came to a correct conclusion, or if the student used sound logic to arrive at a decision.


Thinking out loud makes the clinical thought process EXPLICIT for the student and the instructor. Even when an instructor does not immediately know how to proceed with a patient, thinking out loud and making the thought process and verification process known enhances students' learning experiences. It also models the important process of dealing with clinical uncertainty, a critical component of medical practice.

You can incorporate the “think out loud” strategy into your teaching by:

  • Asking students to not only provide an “answer” but to also identify their rationale for that answer.
  • Asking students what else might be going on and what made them come to one conclusion over the alternatives.
  • Using the “think out loud” strategy to express your thought processes (as the instructor), to students. This takes some practice, but the thoughts are there - it is a matter of speaking them, not just thinking them.
  • Remember, even if you are unsure of the proper course of action, verbalizing the decision-making process to students models two simultaneous processes: 1) decision making (prioritizing certain factors for certain reasons), and 2) finding answers.

Try practicing this approach by preparing a sandwich for lunch when you are at home. As you move through the process of making your sandwich, describe verbally what you are doing during each step and why... something akin to being a chef on the “Food Network.” You will probably notice that it becomes easier to do this once you get started.