Why thinking out loud improves CCE performance

Many candidates worry that thinking out loud will make them appear uncertain. The opposite is true. Verbalising reasoning provides examiners with clear evidence of clinical safety and structure.

“Thinking out loud allows examiners to follow - and reward - safe reasoning.” - A/Prof George Eskander

Clinical exams are not designed to assess silent cognition. They are designed to assess observable, defensible decision-making.

Why silence increases examiner uncertainty

When candidates think silently, examiners cannot assess:

• risk recognition
• prioritisation
• justification of actions
• escalation thresholds
• safety-netting logic

Even correct decisions lose marks when the reasoning pathway is hidden.

How thinking out loud improves scoring

Thinking out loud helps candidates:

• organise their thoughts
• demonstrate safe sequencing
• show awareness of uncertainty
• justify investigations and referrals
• reinforce patient safety

Verbalisation reassures examiners that decisions are deliberate rather than accidental.

What effective verbalisation sounds like

Effective thinking out loud is:

• concise
• structured
• clinically focused
• safety-oriented
• proportionate

It is not rambling or self-doubt.

Conclusion

Thinking out loud transforms internal reasoning into examinable performance. Candidates who verbalise clearly are more likely to score consistently and avoid borderline outcomes.

Reference
Norman G. Research in clinical reasoning: past history and current trends. Medical Education. 2005.