Primary teaching clinics serve as a key platform for cultivating clinical thinking among residents undergoing standardized training in general practice. However, multiple challenges persist, including uneven faculty competency and a lack of systematic teaching approaches. The Murtagh Safe Diagnostic Strategy facilitates the training of general practice clinical thinking, yet its original framework contains redundant content and requires optimization and adaptation to fit the context of primary teaching clinics.

Optimize the Murtagh Safe Diagnostic Strategy and apply it to primary general practice teaching clinics, then collect feedback from instructors and residents to evaluate its teaching effectiveness.

Twenty-four teaching faculty members and 18 residents who participated in a total of 24 teaching clinics at Yuetan Community Health Service Center from July 2024 to June 2025 were selected by the means of purposive sampling. Specialized training on the strategy and on-site practical demonstrations in clinics were provided for teaching staff, combined with mind maps to deliver clinical reasoning teaching. Questionnaires and focus group discussions were adopted to investigate instructors' practical application and feedback on the strategy in primary general practice teaching clinics, while questionnaires were used to assess general practice residents' cognition and feedback regarding the strategy.

All 24 (100.0%) instructors recognized that the Murtagh Safe Diagnostic Strategy was applicable to primary general practice teaching clinics. Nevertheless, only 16 (66.7%) instructors actually adopted this strategy in teaching clinics, mostly for cases of unknown etiology. According to instructors, instructors' own teaching competence and experience, as well as residents' clinical reasoning ability, constituted the major limiting factors for implementing Murtagh Safe Diagnostic Strategy in primary general practice teaching clinics. Among 18 general practice residents, 16 (16/18) reported high familiarity with the Murtagh Safe Diagnostic Strategy, 14 (14/18) frequently and proactively applied it in clinical practice, and 15 (15/18) believed that the strategy could foster general practice clinical thinking. Residents identified insufficient systematic training (n=13) and heavy outpatient workload (n=11) as major barriers to strategy promotion. They expected to strengthen learning via special lectures (n=15), case discussions combined with role-play (n=13), and hands-on practice or demonstration in teaching outpatient clinics (n=13).

The teaching value of the Murtagh Safe Diagnostic Strategy has been recognized by both instructors and residents, as it helps foster residents' clinical thinking. Nevertheless, its actual application rate remains relatively low, and its widespread promotion is constrained by instructors' competence, residents' foundational knowledge, heavy outpatient workload and primary care service conditions. Compared with the management of common chronic diseases and their complications in community settings, this strategy is more frequently adopted in teaching cases requiring clinical reasoning, such as those involving multi-system involvement and unexplained symptoms. Routine specialized training for instructors, case-based practical training and digital teaching tools can facilitate standardized application of the strategy.