Becoming a teacher of clinical reasoning

Diagnosis ◽  
2018 ◽  
Vol 5 (1) ◽  
pp. 11-14 ◽  
Author(s):  
Robert L. Trowbridge ◽  
Andrew P.J. Olson
Keyword(s):  
Clinical Reasoning ◽  
Cognitive Biases ◽  
Diagnostic Reasoning ◽  
Dual Process ◽  
Diagnostic Process ◽  
Clinical Experiences ◽  
Context Specificity ◽  
Clinician Educators ◽  
Medical Educators

AbstractDiagnostic reasoning is one of the most challenging and rewarding aspects of clinical practice. As a result, facility in teaching diagnostic reasoning is a core necessity for all medical educators. Clinician educators’ limited understanding of the diagnostic process and how expertise is developed may result in lost opportunities in nurturing the diagnostic abilities of themselves and their learners. In this perspective, the authors describe their journeys as clinician educators searching for a coherent means of teaching diagnostic reasoning. They discuss the initial appeal and immediate applicability of dual process theory and cognitive biases to their own clinical experiences and those of their trainees, followed by the eventual and somewhat belated recognition of the importance of context specificity. They conclude that there are no quick fixes in guiding learners to expertise of diagnostic reasoning, but rather the development of these abilities is best viewed as a long, somewhat frustrating, but always interesting journey. The role of the teacher of clinical reasoning is to guide the learners on this journey, recognizing true mastery may not be attained, but should remain a goal for teacher and learner alike.

Risk and Reason in Clinical Diagnosis

2019 ◽  
Author(s):  
Cym Anthony Ryle
Keyword(s):  
Medical Diagnosis ◽  
Process Model ◽  
Medical Training ◽  
Diagnostic Reasoning ◽  
Dual Process ◽  
Diagnostic Process ◽  
Near Misses ◽  
Diagnostic Thresholds ◽  
Enhance Patient Safety

This book provides, without the use of specialist language, a description of diagnostic reasoning and error and a discussion of steps that could improve diagnostic accuracy. Drawing on work in cognitive psychology, it presents the key characteristics of human reasoning. It notes that complex cognitive tasks such as medical diagnosis require a synergy of intuition and analytical thinking and introduces the concept of bias. The book considers the value of current classifications of disease, the meaning of diagnostic thresholds, and the potential for overdiagnosis. It examines the role of the patient-centred approach in this context. It develops a description of the diagnostic process, provides illustrative examples and metaphors, and refers to the dual-process model. It suggests that medical training does not consistently provide a coherent account of diagnostic thinking and the associated risks of error. It considers the role of probability in diagnostic reasoning, noting the contribution and the limitations of both informal and mathematical estimates. It refers to clear evidence that error in medical diagnosis is a prevalent and potent cause of harm and may result from systems factors or cognitive glitches such as bias and logical fallacy. It presents cases with commentaries, highlighting the cognitive processes in diagnostic successes, near misses, and disasters. It concludes with proposals for change, notably in institutional culture; in professional culture, education, and training; and in the structure of medical records. The book advocates the development and deployment of computerized diagnostic decision support. It argues that these changes could significantly enhance patient safety.

scholarly journals Clinical Reasoning Terms Included in Clinical Problem Solving Exercises?

2016 ◽  
Vol 8 (2) ◽  
pp. 180-184 ◽  
Author(s):  
John L Musgrove ◽  
Jason Morris ◽  
Carlos A Estrada ◽  
Ryan R Kraemer
Keyword(s):  
Problem Solving ◽  
Clinical Reasoning ◽  
Clinical Problem ◽  
Dual Process ◽  
Problem Representation ◽  
Context Specificity ◽  
Weight Percentage ◽  
Clinical Problem Solving ◽  
Clinician Educators ◽  
Process Thinking

ABSTRACT  Published clinical problem solving exercises have emerged as a common tool to illustrate aspects of the clinical reasoning process. The specific clinical reasoning terms mentioned in such exercises is unknown.Background  We identified which clinical reasoning terms are mentioned in published clinical problem solving exercises and compared them to clinical reasoning terms given high priority by clinician educators.Objective  A convenience sample of clinician educators prioritized a list of clinical reasoning terms (whether to include, weight percentage of top 20 terms). The authors then electronically searched the terms in the text of published reports of 4 internal medicine journals between January 2010 and May 2013.Methods  The top 5 clinical reasoning terms ranked by educators were dual-process thinking (weight percentage = 24%), problem representation (12%), illness scripts (9%), hypothesis generation (7%), and problem categorization (7%). The top clinical reasoning terms mentioned in the text of 79 published reports were context specificity (n = 20, 25%), bias (n = 13, 17%), dual-process thinking (n = 11, 14%), illness scripts (n = 11, 14%), and problem representation (n = 10, 13%). Context specificity and bias were not ranked highly by educators.Results  Some core concepts of modern clinical reasoning theory ranked highly by educators are mentioned explicitly in published clinical problem solving exercises. However, some highly ranked terms were not used, and some terms used were not ranked by the clinician educators. Effort to teach clinical reasoning to trainees may benefit from a common nomenclature of clinical reasoning terms.Conclusions

Clinical reasoning: exploring its characteristics and enhancing its learning

2020 ◽  
Vol 81 (10) ◽  
pp. 1-9
Author(s):  
Mark Gruppetta ◽  
Maria Mallia
Keyword(s):  
Clinical Reasoning ◽  
Data Use ◽  
Dual Process ◽  
Competence Model ◽  
Reasoning Strategies ◽  
Clinical Questions ◽  
Professional Socialisation ◽  
Practice Community ◽  
And Task

Clinical reasoning is an extensive and intricate field, dealing with the process of thinking and decision making in practice. Its study can be quite challenging because it is context and task dependent. Educational frameworks such as the conscious competence model and the dual process reasoning model have been developed to help its understanding. To enhance the learning of clinical reasoning, there are significant areas that can be targeted through learning processes. These include knowledge adequacy; ability to gather appropriate patient data; use of proper reasoning strategies to address specific clinical questions; and the ability to reflect and evaluate on decisions taken, together with the role of the wider practice community and the activity of professional socialisation. This article explores the characteristics of clinical reasoning and delves deeper into the various strategies that prove useful for learning.

scholarly journals Role of intuitive knowledge in the diagnostic reasoning of hospital specialists: a focus group study

BMJ Open ◽  
2019 ◽  
Vol 9 (1) ◽  
pp. e022724 ◽  
Author(s):  
Nydia Van den Brink ◽  
Birgit Holbrechts ◽  
Paul L P Brand ◽  
Erik C F Stolper ◽  
Paul Van Royen
Keyword(s):  
Decision Making ◽  
General Practitioners ◽  
Diagnostic Reasoning ◽  
Dual Process ◽  
Focus Group Study ◽  
Analytical Reasoning ◽  
Gut Feelings ◽  
Data Saturation ◽  
Human Decision

Background and objectiveIntuition is an important part of human decision-making and can be explained by the dual-process theory where analytical and non-analytical reasoning processes continually interact. These processes can also be identified in physicians’ diagnostic reasoning. The valuable role of intuition, including gut feelings, has been shown among general practitioners and nurses, but less is known about its role among hospital specialists. This study focused on the diagnostic reasoning of hospital specialists, how they value, experience and use intuition.Design and participantsTwenty-eight hospital specialists in the Netherlands and Belgium participated in six focus groups. The discussions were recorded, transcribed verbatim and thematically coded. A circular and iterative analysis was applied until data saturation was achieved.ResultsDespite initial reservations regarding the term intuition, all participants agreed that intuition plays an important role in their diagnostic reasoning process. Many agreed that intuition could guide them, but were cautious not to be misguided. They were especially cautious since intuition does not have probative force, for example, in medicolegal situations. ‘On-the-job experience’ was regarded as a precondition to relying on intuition. Some participants viewed intuition as non-rational and invalid. All participants said that intuitive hunches must be followed by analytical reasoning. Cultural differences were not found. Both the doctor as a person and his/her specialty were seen as important determinants for using intuition.ConclusionsHospital specialists use intuitive elements in their diagnostic reasoning, in line with general human decision-making models. Nevertheless, they appear to disagree more on its role and value than previous research has shown among general practitioners. A better understanding of how to take advantage of intuition, while avoiding pitfalls, and how to develop ‘skilled’ intuition may improve the quality of hospital specialists’ diagnostic reasoning.

scholarly journals Increasing the Role of Phenomenology in Psychiatric Diagnosis–The Clinical Staging Approach

2020 ◽  
Vol 45 (6) ◽  
pp. 683-702
Author(s):  
Anna Drożdżowicz
Keyword(s):  
Clinical Reasoning ◽  
Psychiatric Diagnosis ◽  
Diagnostic Reasoning ◽  
Complex Domain ◽  
Clinical Staging ◽  
The Rich

Abstract Recent editions of diagnostic manuals in psychiatry have focused on providing quick and efficient operationalized criteria. Notwithstanding the genuine value of these classifications, many psychiatrists have argued that the operationalization approach does not sufficiently accommodate the rich and complex domain of patients’ experiences that is crucial for clinical reasoning in psychiatry. How can we increase the role of phenomenology in the process of diagnostic reasoning in psychiatry? I argue that this could be done by adopting a clinical staging approach in diagnostic reasoning in psychiatry. The approach has the resources to include the progressive nature of patients’ experiences to a much greater degree than is currently practiced. It can address the recent plea for increasing the role of phenomenology in psychiatric diagnosis by offering a model for clinical reasoning that goes beyond the operationalized, static criteria of diagnostic manuals, without depriving us of their benefits.

scholarly journals Clinical Reasoning in Forensic Psychiatry: Concepts, Processes, and Pitfalls

2021 ◽  
Vol 12 ◽  
Author(s):  
Natalia Widiasih Raharjanti ◽  
Tjhin Wiguna ◽  
Agus Purwadianto ◽  
Diantha Soemantri ◽  
Saptawati Bardosono ◽  
...  
Keyword(s):  
Clinical Reasoning ◽  
Forensic Psychiatry ◽  
Cognitive Biases ◽  
Dual Process ◽  
Potential Threat ◽  
Illness Script ◽  
Professional Opinion ◽  
Forensic Psychiatric ◽  
Definition Of

Forensic psychiatrists are often sought by the court of law to provide professional opinion on specific legal matters that have a major impact on the evaluee and possibly society at large. The quality of that opinion and recommendations rely on the quality of the analysis from the assessment results conducted by the psychiatrist. However, the definition and scope of a forensic psychiatric analysis is not clear. While existing literature on forensic psychiatric analysis generally includes organizing information, identifying relevant details, and formulating a set of forensic psychiatric opinions as components, there is no explicit and unified definition of these terms and process. This lack of clarity and guidelines may hinder forensic psychiatry from achieving its goal of providing objective information to the court or other relevant parties. Forensic psychiatric analysis exhibits numerous parallels to clinical reasoning in other fields of medicine. Therefore, this review aims to elaborate forensic psychiatric analysis through the lens of clinical reasoning, which has been developed by incorporating advances in cognitive sciences. We describe forensic psychiatric analysis through three prominent clinical reasoning theories: hypothetico-deductive model, illness script theory, and dual process theory. We expand those theories to elucidate how forensic psychiatrists use clinical reasoning not only to diagnose mental disorders, but also to determine mental capacities as requested by law. Cognitive biases are also described as potential threat to the accuracy of the assessment and analysis. Additionally, situated cognition theory helps elucidate how contextual factors influence risk of errors. Understanding the processes involved in forensic psychiatric analysis and their pitfalls can assist forensic psychiatrists to be aware of and try to mitigate their bias. Debiasing strategies that have been implemented in other fields of medicine to mitigate errors in clinical reasoning can be adapted for forensic psychiatry. This may also shape the training program of general psychiatrists and forensic psychiatrists alike.

A Response Evocation Program for /ɝ/

1975 ◽  
Vol 40 (1) ◽  
pp. 92-105 ◽  
Author(s):  
Lawrence D. Shriberg
Keyword(s):  
Service Delivery ◽  
Motor Skills ◽  
Task Analysis ◽  
Professional Issues ◽  
Clinical Experiences ◽  
Program Outcomes ◽  
Program Step ◽  
Skills Learning ◽  
Learning Principles

A response evocation program, some principles underlying its development and administration, and a review of some clinical experiences with the program are presented. Sixty-five children with developmental articulation errors of the /ɝ/ phoneme were administered the program by one of 19 clinicians. Approximately 70% of program administrations resulted in a child emitting a good /ɝ/ within six minutes. Approximately 10% of children who were given additional training on program step failures emitted good /ɝ/'s in subsequent sessions. These preliminary observations are discussed in relation to the role of task analysis and motor skills learning principles in response evocation, clinician influences in program outcomes, and professional issues in service delivery to children with developmental articulation errors.

Understanding and reducing tension between science and religion: The role of meaning in social cognitive biases and reducing defensiveness

2014 ◽  
Author(s):  
Daryl R. Van Tongeren ◽  
Jeffrey D. Green ◽  
Timothy L. Hulsey ◽  
Cristine H. Legare ◽  
David G. Bromley ◽  
...  
Keyword(s):  
Social Cognitive ◽  
Cognitive Biases ◽  
Science And Religion

Re-thinking morbidity and mortality

Diagnosis ◽  
2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Sumner Abraham ◽  
Andrew Parsons ◽  
Brian Uthlaut ◽  
Peggy Plews-Ogan
Keyword(s):  
Cognitive Biases ◽  
Diagnostic Errors ◽  
Dual Process ◽  
Morbidity And Mortality ◽  
Dual Process Theory ◽  
Habits Of Mind ◽  
Thought Processes ◽  
University Of Virginia ◽  
Self Reflection ◽  
The University

AbstractDespite the breadth of patient safety initiatives, physicians talking about their mistakes to other physicians is a difficult thing to do. This difficulty may be exacerbated by a limited exposure to how to analyze and discuss mistakes and respond in a productive way. At the University of Virginia, we recognized the importance of understanding cognitive biases for residents in both their clinical and personal professional development. We re-designed our resident led morbidity and mortality (M&M) conference using a model that integrates dual-process theory and metacognition to promote informed reflection and analysis of cognitive diagnostic errors. We believe that structuring M&M in this way builds a culture that encourages reflection together to learn our most difficult diagnostic errors and to engage in where our thought processes went wrong. In slowly building this culture, we hope to inoculate residents with the habits of mind that can best protect them from harmful biases in their clinical reasoning while instilling a culture of self-reflection.

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