The fundamental principles of RP&L include the following:

  • Disciplined examination of reasoning in complex situations
  • Making reasoning explicit and thus open to review and critique by one’s self and others
  • Modifying practice according to insights developed in the process

Making reasoning explicit is the key part of the exercise. Explicit reasoning allows each participant to:

  • Become familiar with their own implicit models for action
  • Rehearse the process of reasoning through difficult circumstances
  • Learn from the experience and perspective of colleagues

The RP&L method shares features with other approaches (e.g., see Michael Balint and Balint Groups 1,2) while emphasizing a group or organizational level of analysis and translating reflection into action. RP&L also employs the Socratic approach — physician facilitators guide discussions during which learners apply a reasoning exercise to the psychological, social, and institutional aspects of their role as physicians.

In the following sections, we will illustrate the RP&L method based on our bi-weekly seminar for fellows in pediatric hematology/oncology. As this is but one example of an RP&L seminar, from here forward, we will refer to the fellows as “participants.”

For more information on adapting this method other medical specialties, settings, and stages of professional development, please see the section on Alternative Designs.


1. Balint M. The doctor, his patient, and the illness. Lancet 1955; 268(6866):683-688.

2. Clarke D, Coleman J. Balint groups. Examining the doctor-patient relationship. Aust Fam Physician 2002; 31(1):41-44.