"Thinking aloud" as a strategy to improve clinical decision making.

Although "thinking aloud" has been used as a research method to collect data about nurses' knowledge and cognitive processes, it has not been used widely for instruction. We suggest that thinking aloud can be an effective teaching strategy for staff development. Two techniques are described for incorporating thinking aloud into dialogue among experienced nurses and into mentoring activities between experts and novices. An excerpt from a transcript of one nurse's thinking aloud while making a triage decision is presented to illustrate the types of knowledge and cognitive processes that can be elicited and revealed by using this strategy. Potential educational benefits are identified, along with suggestions for implementing thinking aloud as an instructional method.