Volume 40 Number 3 | June 2026
Summary

This article argues that medical laboratory education must evolve beyond memorization to emphasize diagnostic reasoning. It highlights the importance of case-based learning, simulation, and reflective practices to develop analytical thinking. By fostering pattern recognition, clinical interpretation, and confidence, educators can better prepare students to contribute meaningfully to modern patient care.

Stephanie B. Cochrane, EdD, MLS(ASCP)CM, ASCLS Clinical Laboratory Educators Forum Chair

Stephanie CochraneThe medical laboratory science profession is rapidly evolving. Advances in diagnostic technology and automation, increasing test complexity, artificial intelligence, and the growing demand for timely clinical decision support are transforming laboratory workflows and the role of the laboratory professional. Today’s laboratorians are not simply performing tests; they are interpreting data, recognizing patterns, troubleshooting discrepancies, and collaborating with healthcare teams to ensure accurate and meaningful results. Hence, as the profession evolves, so too must the way we educate the next generation of medical laboratory science professionals.

While foundational knowledge remains essential, memorization alone does not adequately prepare students for the complex decision-making they will encounter in the laboratory. The goal is for educators to shift away from traditional memorization-heavy models of instruction and more towards approaches that cultivate diagnostic reasoning. Tasks such as interpreting incomplete or conflicting information or determining whether an unexpected result represents a true patient finding, a pre-analytical error, or an analytical issue require higher order thinking skills such as analysis, interpretation, and clinical correlation. Therefore, preparing practice-ready graduates requires developing not only technical competence, but also the analytical mindset that allows laboratorians to think like diagnosticians. 

Diagnostic Reasoning in Laboratory Medicine

Diagnostic reasoning has long been emphasized in medical education; however, its relevance to laboratory practice involves synthesizing multiple sources of information including patient history, laboratory data, morphology, and follow-up testing to arrive at a logical interpretation.1

For example, when evaluating hematology results, a laboratorian might integrate CBC parameters, red blood cell morphology, and clinical context to recognize patterns consistent with iron deficiency anemia or a hemolytic process. In microbiology, recognizing growth characteristics and biochemical reactions allows laboratorians to narrow down organism identification. Across disciplines, the ability to interpret data and recognize patterns is essential for ensuring accurate diagnosis and optimal patient care. By intentionally incorporating diagnostic reasoning into laboratory education, we help students develop the mindset required to navigate these complex scenarios. 

“The shift from memorization to diagnostic reasoning represents more than a pedagogical trend. It reflects a broader evolution in how the laboratory profession contributes to patient care.”

Creating Learning Experiences that Mirror Practice

One of the most effective ways to cultivate diagnostic reasoning is through authentic, case-based learning experiences that mirror authentic clinical situations.2 Instead of presenting laboratory tests as isolated facts, educators can introduce them through patient cases that require students to analyze data, formulate hypotheses, and justify their conclusions. Through guided discussion and reflection, students learn to connect laboratory findings to underlying disease mechanisms.

Simulation-based activities can further enhance this process. Diagnostic case boards, laboratory data interpretation exercises, and collaborative problem-solving activities encourage students to actively engage with laboratory data rather than passively receiving information. These approaches also promote teamwork and communication, skills that are increasingly important as laboratory professionals interact more frequently with clinicians and interdisciplinary healthcare teams.3 

Building Diagnostic Confidence

Developing diagnostic reasoning is not simply about solving cases; it is also about building confidence in decision-making. Students must become comfortable evaluating uncertainty, defending their reasoning, and revising their conclusions when new information emerges.

Educators can support this process by incorporating semi-structured reflection (e.g., reflective journaling) and iterative feedback into learning activities. After working through a case, students may be asked to explain how they arrived at their conclusion, identify alternative possibilities, and consider what additional data might strengthen their interpretation. These reflective exercises help students develop metacognitive awareness, an important skill for lifelong learning and professional growth.4,5

Over time, repeated exposure to diagnostic scenarios allows students to develop pattern recognition and clinical intuition. What initially feels complex and overwhelming gradually becomes more intuitive as students build mental frameworks for interpreting laboratory data. 

Integrating Diagnostic Reasoning across my Hematology Curriculum

In my own teaching, I am intentionally working to integrate diagnostic reasoning across my two hematology courses, creating a developmental progression that mirrors how expertise develops in practice. In Hematology I, where students are first introduced to foundational laboratory concepts, I have begun incorporating a diagnostic reasoning lens directly into the course structure. Within each Canvas module, I have a lesson introduction page that explains why this lesson/topic matters and how it contributes to diagnostic reasoning in laboratory medicine. These brief explanations will help students connect foundational concepts such as CBC interpretation, cell morphology, or hematopoiesis to the broader process of clinical diagnosis.

At the same time, I am developing a conceptual framework that spans both Hematology I and Hematology II, outlining how diagnostic reasoning skills evolve across the curriculum. In this model, Hematology I focuses on building foundational pattern recognition, including understanding normal versus abnormal findings, recognizing morphological variations, and interpreting core laboratory parameters. Hematology II then expands these skills into disease-based reasoning, where students apply their foundational knowledge to complex patient cases involving coagulopathies, anemias, and hematologic malignancies. To support this transition, I’m planning to implement structured, low stakes learning labs to immerse students in applied problem-solving. In these learning labs, students will analyze patient cases, evaluate laboratory data, and work collaboratively to construct diagnostic interpretations. 

Educators as Architects of the Profession’s Future

Clinical laboratory educators play a critical role in shaping the future of the profession. By designing learning experiences that emphasize analytical thinking, clinical context, and collaborative problem-solving, we help students develop the skills necessary to thrive in modern laboratory practice. The ASCLS Clinical Laboratory Educators Forum (CLEF) provides valuable opportunities for educators to share teaching innovations, develop educational resources, and collaborate on strategies that strengthen laboratory education nationwide. Through these collaborative efforts, educators can continue advancing pedagogical approaches that prepare students for the realities of modern (and future) laboratory medicine.

The shift from memorization to diagnostic reasoning represents more than a pedagogical trend. It reflects a broader evolution in how the laboratory profession contributes to patient care. By teaching students to think like diagnosticians, we empower them to become confident, capable professionals who will help lead the laboratory into the future.

References
  1. Li, S., Tan, X., Fang, J., Dong, J. (2025). Enhancing clinical reasoning skills through tailored CPC in pathology laboratory instruction. Frontiers in Medicine, 12. https://doi.org/10.3389/fmed.2025.1566097
  2. Das, S., Sas, A., Rai, P., Kumar, N. (2021). Case-based learning: Modern teaching tool meant for present curriculum: A behavioral analysis from faculties’ perspective. Journal of Education and Health Promotion, 10(1). https://doi.org/10.4103/jehp.jehp_1265_20
  3. Chukwuka, E., et al. (2024). The impact of simulation-based training in medical education. A review. Medicine, 103(7). https://doi.org/10.1097/MD.0000000000038813
  4. Alt, D., & Raichel, N. (2020). Reflective journaling and metacognitive awareness: Insights from a longitudinal study in higher education. Reflective Practice, 21(2), 145-158. https://doi.org/10.1080/14623943.2020.1716708
  5. Petersen, L.A., Delkoski, S., McCarthy, S. (2025). Diagnostic reasoning for APRN learners: Overview of teaching strategies. AACN Advanced Critical Care, 36(2), 131-142. https://doi.org/10.4037/aacnacc2025341

Stephanie B. Cochrane is Assistant Professor at Rutgers University School of Health Professions in Newark, New Jersey.