Clinical Reasoning Tasks and Resident Physicians: What Do They Reason About?
| Autor: | Lambertus Schuwirth, Jennifer Masel, Temple Ratcliffe, Elexis McBee, Mark Goldszmidt, Katherine Picho, Steven J. Durning, Anthony R. Artino |
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| Přispěvatelé: | RS: SHE School of Health Professions Education, Onderwijsontw & Onderwijsresearch |
| Jazyk: | angličtina |
| Rok vydání: | 2016 |
| Předmět: |
Male
020205 medical informatics Clinical Decision-Making Video Recording MEDLINE 02 engineering and technology California Education Thinking 03 medical and health sciences 0302 clinical medicine Clinical decision making Physicians Internal Medicine 0202 electrical engineering electronic engineering information engineering Humans Medicine 030212 general & internal medicine Medical diagnosis Video recording business.industry Clinical reasoning Internship and Residency General Medicine Female business Social psychology Cognitive psychology |
| Zdroj: | Academic Medicine, 91(7), 1022-1028. LIPPINCOTT WILLIAMS & WILKINS |
| ISSN: | 1040-2446 |
| Popis: | PURPOSE A framework of clinical reasoning tasks thought to occur in a clinical encounter was recently developed. It proposes that diagnostic and therapeutic reasoning comprise 24 tasks. The authors of this current study used this framework to investigate what internal medicine residents reason about when they approach straightforward clinical cases. METHOD Participants viewed three video-recorded clinical encounters portraying common diagnoses. After each video, participants completed a post encounter form and think-aloud protocol. Two authors analyzed transcripts from the think-aloud protocols using a constant comparative approach. They conducted iterative coding of the utterances, classifying each according to the framework of clinical reasoning tasks. They evaluated the type, number, and sequence of tasks the residents used. RESULTS Ten residents participated in the study in 2013-2014. Across all three cases, the residents employed 14 clinical reasoning tasks. Nearly all coded tasks were associated with framing the encounter or diagnosis. The order in which residents used specific tasks varied. The average number of tasks used per case was as follows: Case 1, 4.4 (range 1-10); Case 2, 4.6 (range 1-6); and Case 3, 4.7 (range 1-7). The residents used some tasks repeatedly; the average number of task utterances was 11.6, 13.2, and 14.7 for, respectively, Case 1, 2, and 3. CONCLUSIONS Results suggest that the use of clinical reasoning tasks occurs in a varied, not sequential, process. The authors provide suggestions for strengthening the framework to more fully encompass the spectrum of reasoning tasks that occur in residents' clinical encounters. |
| Databáze: | OpenAIRE |
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