Clinical Reasoning
Clinical Reasoning in the Health Professions by
Look for the print edition in Miner Library Books Upper Level Stacks! Clinical reasoning lies at the core of health care practice and education. Clinical Reasoning in the Health Professions, therefore, occupies a central place in the education of health professionals, the enhancement of professional decision making of individuals and groups of practitioners with their clients, and research into optimal practice reasoning. This is a book for teachers and learners, practitioners, practice leaders, researchers and curriculum managers. Indeed, it is a valuable resource for educators seeking to ground their teaching practices in educational theory, sound knowledge of clinical reasoning and practice-based evidence, and researchers seeking to expand their research horizons.
Call Number: Print book available at Miner Library: W 21 C641 2019ISBN: 9780702062247Publication Date: 2018-10-16
- Bowen J. L. (2006). Educational strategies to promote clinical diagnostic reasoning. The New England Journal of Medicine, 355(21), 2217–2225. https://doi.org/10.1056/NEJMra054782 Clinical teachers differ from clinicians in a fundamental way. They must simultaneously foster high-quality patient care and assess the clinical skills and reasoning of learners in order to promote their progress toward independence in the clinical setting. Clinical teachers must diagnose both the patient's clinical problem and the learner's ability and skill. To assess a learner's diagnostic reasoning strategies effectively, the teacher needs to consider how doctors learn to reason in the clinical environment.
- Brush, J. E., Jr, Sherbino, J., & Norman, G. R. (2022). Diagnostic reasoning in cardiovascular medicine. BMJ (Clinical research ed.), 376, e064389. https://doi.org/10.1136/bmj-2021-064389 Increased knowledge about the cognitive psychology of the diagnostic process and the pitfalls inherent in the process may inform clinical teachers and help learners and clinicians to improve the accuracy of diagnostic reasoning. This article reviews the literature on the cognitive psychology of diagnostic reasoning in the context of cardiovascular disease.
- Dhaliwal G. (2017). Premature closure? Not so fast. BMJ Quality & Safety, 26(2), 87–89. https://doi.org/10.1136/bmjqs-2016-005267 Dual process theory (DPT) and the intertwined concepts of heuristics and biases, popularised by Kahneman's book Thinking Fast and Slow, are widely discussed models for analysing decision-making processes inside and outside medicine.1 The basic premise of DPT is that the brain has a fast, intuitive, but occasionally error-prone system (system 1) and a slower, energy-intensive but more accurate analytical system (system 2). Inexorably tied up with the DPT model is the idea that the errors made in system 1 are a result of shortcuts (heuristics) and predispositions (biases) and the hope that if we spent more time in system 2, cognitive errors could be mitigated. Insights from this model have driven quality improvement and medical education efforts. Learning about how our brain succeeds and fails is interesting, humbling and motivating—but is it effective?
- Society of General Internal Medicine. (n.d.). Clinical reasoning exercises. Retrieved March 10, 2023, from https://www.sgim.org/web-only/clinical-reasoning-exercises The Exercises in Clinical Reasoning (ECR) section of JGIM Web provides tools for faculty and trainees interested in both learning and explicitly teaching core concepts in clinical reasoning. Ultimately, we aim to have a positive impact on students and trainees as they develop expertise in the diagnostic process, with the core aim of improving patient care. The ECR series utilizes a clinical problem-solving format and then includes a meta-cognitive commentary to decipher the clinical reasoning process used by expert diagnosticians. This parallel process allows the reader to understand the framework by which the clinician solves (or doesn’t solve) the case. On this page, you will find a downloadable curriculum built on the ECR series designed to help clinician educators learn and teach critical reasoning concepts. Each case on the website will include an introduction to the clinical reasoning concept highlighted in the case, downloadable teaching slides, which include an embedded instructor’s guide, and links to other clinical reasoning resources. We hope that the ECR website will inspire others to use clinical reasoning concepts to enhance their teaching, and potentially, and will even motivate some educators to submit their work to the JGIM ECR series.
Cognitive Bias
- Croskerry P. (2002). Achieving quality in clinical decision making: cognitive strategies and detection of bias. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, 9(11), 1184–1204. In addition to the traditional hypothetico-deductive method, emergency physicians use several other approaches, principal among which are heuristics. When they [fail], we refer to them as cognitive errors. It is important that emergency physicians be aware of the nature and extent of these heuristics and biases, or cognitive dispositions to respond (CDRs).
- Croskerry P. (2003). The importance of cognitive errors in diagnosis and strategies to minimize them. Academic medicine : journal of the Association of American Medical Colleges, 78(8), 775–780. In the area of patient safety, recent attention has focused on diagnostic error. A critical subset of diagnostic errors arises through cognitive errors, especially those associated with failures in perception, failed heuristics, and biases; collectively, these have been referred to as cognitive dispositions to respond (CDRs). The author provides an extensive list of CDRs and a list of strategies to reduce diagnostic errors.
- Croskerry P. (2013). From mindless to mindful practice--cognitive bias and clinical decision making. The New England journal of medicine, 368(26), 2445–2448. The two major products of clinical decision making are diagnoses and treatment plans. If the first is correct, the second has a greater chance of being correct too. Surprisingly, we don't make correct diagnoses as often as we think: the diagnostic failure rate is estimated to be 10 to 15%.
- Croskerry P. Diagnostic Failure: A Cognitive and Affective Approach. In: Henriksen K, Battles JB, Marks ES, et al., editors. Advances in Patient Safety: From Research to Implementation (Volume 2: Concepts and Methodology). Rockville (MD): Agency for Healt The impact of diagnostic failure on patient safety does not appear to have been fully recognized. Ideally, all information used in diagnostic reasoning is objective and all thinking is logical and valid, but these conditions are not always met. Two major phenomena that may undermine objectivity and rational thinking are cognitive dispositions to respond (CDRs) and affective dispositions to respond (ADRs) toward the patient. In this report, the determinants and characteristics of the major CDRs and ADRs are reviewed, as are a variety of de-biasing strategies that may mitigate their influence.
Remediating Clinical Reasoning
- Audétat, M., Laurin, S., Dory, V., Charlin, B., & Nendaz, M. R. (2017). Diagnosis and management of clinical reasoning difficulties: Part I. clinical reasoning supervision and educational diagnosis. Medical Teacher, 39(8), 792-796. There are many obstacles to the timely identification of clinical reasoning difficulties in health professions education. This guide aims to provide readers with a framework for supervising clinical reasoning and identifying the potential difficulties as they may occur at each step of the reasoning process.
- Audétat, M., Laurin, S., Dory, V., Charlin, B., & Nendaz, M. R. (2017). Diagnosis and management of clinical reasoning difficulties: Part II. clinical reasoning difficulties: Management and remediation strategies. Medical Teacher, 39(8), 797-801. Part II of this AMEE Guide provides a detailed overview of the main difficulties in clinical reasoning, including the cues to look out for in clinical supervision, the root causes of each difficulty and targeted remediation strategies. Specific challenges and issues related to the management of clinical reasoning difficulties will also be discussed.
- Audétat, M., Laurin, S., Sanche, G., Béïque, C., Fon, N. C., Blais, J., & Charlin, B. (2013). Clinical reasoning difficulties: A taxonomy for clinical teachers. Medical Teacher, 35(3), e984-e989. Aim: [1] To identify the most common clinical reasoning difficulties as they present in residents’ patient encounters, case summaries, or medical notes. [2] To develop a guide to support medical educators’ process of educational diagnosis and management in this area.
- Dhaliwal, G. (2013). Developing teachers of clinical reasoning. The Clinical Teacher, 10(5), 313-317. Front-line teachers seek guidance and tools to instruct and remediate clinical reasoning, but effective professional development methods to accomplish these goals have not been reported.Similarly structured faculty development seminars may help bring insights from clinical reasoning theory to bedside and classroom instruction.
- Guerrasio, J., & Aagaard, E. M. (2014). Methods and outcomes for the remediation of clinical reasoning. Journal of General Internal Medicine, 29(12), 1607-1614. AIM: To assess the effectiveness of a standardized clinical reasoning remediation plan for medical learners at various stages of training.