Clinical Reasoning - Science topic

That's exactly my concern.

Yes I agree to a large extent as most political debates produces the surface intent of the problems. The real causative entity of the symptoms are unfolded when diagnostic tests are applied analysed and evidence based prescription applied

The think-aloud technique should be utilized as one of the data collection methods. Decision-making is the result of a series of preceding thought processes, and concurrent think-aloud is the most effective method for learning the thought processes in the working memory.

Inga Hege - Thank you for your question. In a medical curriculum that aims at competence, clinical reasoning and justification should be clearly defined in the curriculum and teaching/learning activities. This emphasis should be shown throughout the academic years. For example, in the early preclinical years, PBL should be designed to include in the template of cases, clinical reasoning, justification, interpretation of findings, weighing evidence for a hypothesis etc. In the clinical years, clinical reasoning could be taught in clinical simulation sessions and clinical skills, in case-based learning, in e-cases such as DXR, in case discussion and case presentation.

Indeed, but I still have doubts about the level of anxiety that students have when encountering a simulated situation as compared to the real-life one. surely, there is a difference. Therefore, the ability of students to make decisions would be different as well. The whole story that lingers in my mind is whether students truly learn how to manage serious patient situations and make sound decisions based on their learning experiences from using simulated ones or not.

Dear colleagues,

Thank you all for your input. In summary, one persistent criticism is a strict adherence to the evidence pyramid with the RCT as gold standard over other study designs. There is little evidence for significant differences in treatment effectiveness between RCTs and observational studies.

The interest of patients and physiotherpists (and other allied health care professionals) focuses on 'real-world' settings based on 'real-world data' and 'real-world evidence'.

We have prepared an Editorial about this theme en it is accepted for publication (van Trijffel E, Oostendorp RAB, Elvers JWH. Routinly collected data as real-world evidence for physiotherapy practice. Physiotheapy Theory and Practice, accepted).

Thank you agian and warm greetings,

also on behalf of Emiel van Trijffel and Hans Elvers,

Rob Oostendorp.

The quick answer to your good question is "yes". But the longer answer is very complex. I've attached a more recent chapter on CTA in Health Care. It describes a number of CTA's that are outside of surgery. What I find interesting is why you would assume that "clinical" CTA's would be different than "analytically based" CTA. Both are always involved and combined in expertise. The fact that you ask the question makes me wonder what CTA system you are using. To implement the type of CTA that meta analyses have found work requires identifying and combining both procedural (clinical) and cognitive (analytical) knowledge necessary to succeed at all tasks. Experts are often wrongly convinced that the use of analytical knowledge (declarative, less automated) is somehow separate from clinical knowledge (procedural, automated). The two area almost always used together in every type of expertise. Analytical knowledge tends to focus on the novel elements of a diagnostic or treatment challenge whereas clinical expertise handles the more familiar elements - but both appear to be used in conjunction. The benefit of CTA is to uncover the huge contribution of the non-conscious component of expertise that often requires years to develop. I've covered some of these issues in the attached chapter. Best of luck with what sounds like a very interesting project.

Hi Mark,

Thank you for your recommendation, I will surley look into it.

I probably should have taken this question down since we moved past the collection of data and now working on a manuscript for an article.

Regards,

Ulf

Sorry Rob. It looks like some of the hyperlinks where bunched together when pasting them into my response, and some where double. I hope that this works better.

https://hms.harvard.edu/sites/default/files/assets/Sites/Academy/files/Nouh-ScriptConcordanceTest.pdf

Kind regards,

Adrian

Generally, turning off life support leads to death which most legal system consider a crime and unethical especially where there is no advance directive or it is done without the consent of the patient, same could be done safely with a court order though

as in the case of Nancy Cruzan and Quin Ann.

Dear Mark,

I found some articles which I hope will be helpful. James.

Reyna, V.F (2004). How People Make Decisions That Involve Risk. A Dual Process Approach. Current Directions in Psychological Science, 13(2), 60-66. https://books.apa.org/about/gr/science/advocacy/2004/reyna.pdf

Slovic, P., Peters, E., Finucane, M.L. & MacGregor, D.G. (2005). Affect, Risk, and Decision Making. Health Psychology, 24(4), S35–S40. https://s3.amazonaws.com/academia.edu.documents/30741835/2005_SlovicPetersFinucaneMacGregor_HealthPsych_special_issue_538.pdf?AWSAccessKeyId=AKIAIWOWYYGZ2Y53UL3A&Expires=1506083561&Signature=p0A2pHfWb0mVsMfrXpJR3OVLJWg%3D&response-content-disposition=inline%3B%20filename%3DAffect_risk_and_decision_making.pdf

Vincent, R., Taylor-Adams, S. & Stanhope, N. (1998). Framework for analysing risk and safety in clinical medicine. BMJ, 316(138), 1154-1157. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1112945/

Hunink, M.G.M. & Glasziou, P.P. (2003). Decision making in health and medicine: Integrating evidence and values. Cambridge University Press.

SIMMONS B. (2010) Clinical reasoning: concept analysis. Journal of Advanced Nursing 66(5), 1151–1158. doi: 10.1111/j.1365-2648.2010.05262.x

Moskowitz et al (1998). Dealing with Uncertainty, Risks, and Tradeoffs in Clinical Decisions: A Cognitive Science Approach. Ann Intern Med.108(3), 435-449. DOI: 10.7326/0003-4819-108-3-435

Reyna, V. F., & Lloyd, F. J. (2006). Physician decision making and cardiac risk: Effects of knowledge, risk perception, risk tolerance, and fuzzy processing. Journal of Experimental Psychology: Applied, 12(3), 179-195.

“The Evidence Base of Clinical Diagnosis,” (J A Knottnerus, editor)

Yes, I agree with Maria Bettencourt Pires. What I feel, Clinical reasoning should be introduced to medical students as early as possible. It added more perfection in the assessment ability of the future practitioners.

Dear Saima following URL may help you:

 http://www.biomedcentral.com/1472-6920/14/20

Thanks Peter, I'll drop her an email now

Hi Rabin,

Thanks for your really detailed response I've been doing some reading around dual process theory (Pat Croskerry has written a couple of nice articles), but haven't come across the naturalistic model, so I'll look that up thanks.

I'm working up an observational study investigating how clinical staff review images and make clinical/patient management decisions in the oncology setting.

I'll check out those references thanks and would appreciate any other thoughts you have.

Good luck with the publication

Best wishes

Mark

Yes a lot of them. Check models in the Psychology models. I have  a book on Theory at a Glance...send me your email, will forward the book to you. You can take look at Social Cognitive theory

thank you Carla, will check the instrument as suggested.