Teamwork in clinical reasoning – cooperative or parallel play?

Diagnosis ◽  
2020 ◽  
Vol 7 (3) ◽  
pp. 307-312 ◽  
Author(s):  
Andrew P.J. Olson ◽  
Steven J. Durning ◽  
Carolina Fernandez Branson ◽  
Brian Sick ◽  
Kathleen P. Lane ◽  
...  
Keyword(s):  
Health Care ◽  
Clinical Reasoning ◽  
Distributed Cognition ◽  
Social Cognitive ◽  
Diagnostic Process ◽  
Clinical Context ◽  
High Quality ◽  
Cognitive Theories ◽  
Parallel Play ◽  
Social Cognitive Theories

AbstractTeamwork is fundamental for high-quality clinical reasoning and diagnosis, and many different individuals are involved in the diagnostic process. However, there are substantial gaps in how these individuals work as members of teams and, often, work is done in parallel, rather than in an integrated, collaborative fashion. In order to understand how individuals work together to create knowledge in the clinical context, it is important to consider social cognitive theories, including situated cognition and distributed cognition. In this article, the authors describe existing gaps and then describe these theories as well as common structures of teams in health care and then provide ideas for future study and improvement.

Situativity: a family of social cognitive theories for understanding clinical reasoning and diagnostic error

Diagnosis ◽  
2020 ◽  
Vol 7 (3) ◽  
pp. 169-176 ◽  
Author(s):  
Jerusalem Merkebu ◽  
Michael Battistone ◽  
Kevin McMains ◽  
Kathrine McOwen ◽  
Catherine Witkop ◽  
...  
Keyword(s):  
Clinical Reasoning ◽  
Distributed Cognition ◽  
Social Cognitive ◽  
Diagnostic Error ◽  
Dynamic Interactions ◽  
Clinical Encounters ◽  
Cognitive Theories ◽  
Context Specific ◽  
Social Cognitive Theories ◽  
Physician Patient

AbstractThe diagnostic error crisis suggests a shift in how we view clinical reasoning and may be vital for transforming how we view clinical encounters. Building upon the literature, we propose clinical reasoning and error are context-specific and proceed to advance a family of theories that represent a model outlining the complex interplay of physician, patient, and environmental factors driving clinical reasoning and error. These contemporary social cognitive theories (i.e. embedded cognition, ecological psychology, situated cognition, and distributed cognition) can emphasize the dynamic interactions occurring amongst participants in particular settings. The situational determinants that contribute to diagnostic error are also explored.

scholarly journals Widening the lens on teaching and assessing clinical reasoning: from “in the head” to “out in the world”

Diagnosis ◽  
2020 ◽  
Vol 7 (3) ◽  
pp. 181-190 ◽  
Author(s):  
Dario Torre ◽  
Steven J. Durning ◽  
Joseph Rencic ◽  
Valerie Lang ◽  
Eric Holmboe ◽  
...  
Keyword(s):  
Clinical Reasoning ◽  
Distributed Cognition ◽  
Social Cognitive ◽  
Traditional Teaching ◽  
Educational Approach ◽  
Performance Simulation ◽  
Stimulated Recall ◽  
The Individual ◽  
Design Of Learning Environments ◽  
Social Cognitive Theories

AbstractTraditional teaching and assessment of clinical reasoning has focused on the individual clinician because of the preeminence of the information processing (IP) theory perspective. The clinician’s mind has been viewed as the main source of effective or ineffective reasoning, and other participants, the environment and their interactions have been largely ignored. A social cognitive theoretical lens could enhance our understanding of how reasoning and error and the environment are linked. Therefore, a new approach in which the clinical reasoning process is situated and examined within the context may be required. The theories of embodied cognition, ecological psychology, situated cognition (SitCog) and distributed cognition (DCog) offer new insights to help the teacher and assessor enhance the quality of clinical reasoning instruction and assessment. We describe the teaching and assessment implications of clinical reasoning and error through the lens of this family of theories. Direct observation in different contexts focused on individual and team performance, simulation (with or without enhancement of technology), stimulated recall, think-aloud, and modeling are examples of teaching and assessment strategies grounded in this family of social cognitive theories. Educators may consider the instructional design of learning environments and educational tools that promote a situated educational approach to the teaching and assessment of clinical reasoning.

scholarly journals A situated cognition model for clinical reasoning performance assessment: a narrative review

Diagnosis ◽  
2020 ◽  
Vol 7 (3) ◽  
pp. 227-240 ◽  
Author(s):  
Joseph Rencic ◽  
Lambert W.T. Schuwirth ◽  
Larry D. Gruppen ◽  
Steven J. Durning
Keyword(s):  
Performance Assessment ◽  
Conceptual Model ◽  
Clinical Reasoning ◽  
Social Cognitive ◽  
Contextual Factors ◽  
Situated Cognition ◽  
Context Specificity ◽  
Cognitive Theories ◽  
Social Cognitive Theories ◽  
The Impact

AbstractBackgroundClinical reasoning performance assessment is challenging because it is a complex, multi-dimensional construct. In addition, clinical reasoning performance can be impacted by contextual factors, leading to significant variation in performance. This phenomenon called context specificity has been described by social cognitive theories. Situated cognition theory, one of the social cognitive theories, posits that cognition emerges from the complex interplay of human beings with each other and the environment. It has been used as a valuable conceptual framework to explore context specificity in clinical reasoning and its assessment. We developed a conceptual model of clinical reasoning performance assessment based on situated cognition theory. In this paper, we use situated cognition theory and the conceptual model to explore how this lens alters the interpretation of articles or provides additional insights into the interactions between the assessee, patient, rater, environment, assessment method, and task.MethodsWe culled 17 articles from a systematic literature search of clinical reasoning performance assessment that explicitly or implicitly demonstrated a situated cognition perspective to provide an “enriched” sample with which to explore how contextual factors impact clinical reasoning performance assessment.ResultsWe found evidence for dyadic, triadic, and quadratic interactions between different contextual factors, some of which led to dramatic changes in the assessment of clinical reasoning performance, even when knowledge requirements were not significantly different.ConclusionsThe analysis of the selected articles highlighted the value of a situated cognition perspective in understanding variations in clinical reasoning performance assessment. Prospective studies that evaluate the impact of modifying various contextual factors, while holding others constant, can provide deeper insights into the mechanisms by which context impacts clinical reasoning performance assessment.

Recovery in the Clubhouse Environment: Applying Ecological and Social Cognitive Theories

2013 ◽  
Vol 7 (2) ◽  
pp. 151-165 ◽  
Author(s):  
Francesca Pernice-Duca ◽  
Barry Markman ◽  
Heather Chateauvert
Keyword(s):  
Social Cognitive ◽  
Cognitive Theories ◽  
Social Cognitive Theories

scholarly journals Possible cognitive processes underlying competency assessment

2003 ◽  
Vol 29 (3) ◽  
Author(s):  
A. B. Boshoff ◽  
R. Van Wyk ◽  
C. L. Bester
Keyword(s):  
Cognitive Processes ◽  
Social Cognitive ◽  
Frame Of Reference ◽  
Competency Assessment ◽  
New Paradigm ◽  
Cognitive Evaluation ◽  
Cognitive Theories ◽  
Cognitive Choice ◽  
Theoretical Frame ◽  
Social Cognitive Theories

Indications are that research on competency assessment lacks a theoretical frame of reference. An attempt is made to explore cognitive processes taking place during assessment explaining the large percentage of rater variance. The principles of five different cognitive theories are discussed in the search for possible explanations namely: cognitive choice-, cognitive evaluation-, social cognitive theories, metacognitive- and the new paradigm approaches.

Improving diagnosis by improving education: a policy brief on education in healthcare professions

Diagnosis ◽  
2018 ◽  
Vol 5 (3) ◽  
pp. 107-118 ◽  
Author(s):  
Mark L. Graber ◽  
Joseph Rencic ◽  
Diana Rusz ◽  
Frank Papa ◽  
Pat Croskerry ◽  
...  
Keyword(s):  
Health Care ◽  
Clinical Reasoning ◽  
Health Care Professionals ◽  
Interprofessional Education ◽  
Safety Concern ◽  
Diagnostic Error ◽  
Education And Training ◽  
Diagnostic Process ◽  
Specific Content ◽  
And Training

Abstract Diagnostic error is increasingly recognized as a major patient safety concern. Efforts to improve diagnosis have largely focused on safety and quality improvement initiatives that patients, providers, and health care organizations can take to improve the diagnostic process and its outcomes. This educational policy brief presents an alternative strategy for improving diagnosis, centered on future healthcare providers, to improve the education and training of clinicians in every health care profession. The hypothesis is that we can improve diagnosis by improving education. A literature search was first conducted to understand the relationship of education and training to diagnosis and diagnostic error in different health care professions. Based on the findings from this search we present the justification for focusing on education and training, recommendations for specific content that should be incorporated to improve diagnosis, and recommendations on educational approaches that should be used. Using an iterative, consensus-based process, we then developed a driver diagram that categorizes the key content into five areas. Learners should: 1) Acquire and effectively use a relevant knowledge base, 2) Optimize clinical reasoning to reduce cognitive error, 3) Understand system-related aspects of care, 4) Effectively engage patients and the diagnostic team, and 5) Acquire appropriate perspectives and attitudes about diagnosis. These domains echo recommendations in the National Academy of Medicine’s report Improving Diagnosis in Health Care. The National Academy report suggests that true interprofessional education and training, incorporating recent advances in understanding diagnostic error, and improving clinical reasoning and other aspects of education, can ultimately improve diagnosis by improving the knowledge, skills, and attitudes of all health care professionals.

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