Introduction to Clinical Reasoning
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Introduction[edit | edit source]
Definitions of Clinical Reasoning
There are multiple different definition of clinical reasoning. Some of these definitions are listed here.
"Clinical reasoning (or practice decision making) is a context-dependent way of thinking and decision making in professional practice to guide practice actions."Chapter 1 Higgs and Jensen in Higgs Clinical Reasoning in Health Professionals
"Clinical reasoning refers to the thinking and decision-making processes that are used in clinical practice." Edwards I, Jones M, Carr J, Braunack-Mayer A, Jensen GM. Clinical reasoning strategies in physical therapy. Physical therapy. 2004 Apr 1;84(4):312-30.
Clinical reasoning in physical therapy could be conceptualised as "integrating cognitive, psychomotor, and affective skills. It is contextual in nature and involves both therapist and client perspectives. It is adaptive, iterative, and collaborative with the intended outcome being a biopsychosocial approach to patient/client management." Huhn K, Gilliland SJ, Black LL, Wainwright SF, Christensen N. Clinical reasoning in physical therapy: a concept analysis. Physical therapy. 2019 Apr;99(4):440-56.
In occupational therapy clinically reasoning is defined asda Silva Araujo A, Anne Kinsella E, Thomas A, Demonari Gomes L, Quevedo Marcolino T. Clinical Reasoning in Occupational Therapy Practice: A Scoping Review of Qualitative and Conceptual Peer-Reviewed Literature. The American Journal of Occupational Therapy. 2022 May 1;76(3):7603205070.: (also refer to references within this reference)
"a largely tacit, highly imagistic and deeply phenomenological mode of thinking"
" the process used by practitioners to plan, direct, perform and reflect on client care
"as a mode of thought that involves all the thinking processes of the clinician as s/he moves into, through and out of the therapeutic relationship and therapy process with a client"
Clinical reasoning is "a process in which the therapist, interacting with the patient and others (s8such as family members or others providing care), helps patients structure meaning, goals, and health management strategies based on clinical data, patient choices, and professional judgement and knowledge."Higgs and Jones in Edwards
Clinical reasoning is defined as a complex cognitive process leading to meaningful interpretation of patients' problems and formulation of an effective management plan" Modi JN, Anshu Gupta P and Singh T. Teaching and assessing clinical reasoning skills. Indian Pediatr 2015; 52(9):787–794 in Spaulding SE, Yamane A, McDonald CL, Spaulding SA. A conceptual framework for orthotic and prosthetic education. Prosthetics and Orthotics International. 2019 Aug;43(4):369-81.
Clinical reasoning reflects the thinking or reasoning that a health practitioner engages in to solve and manage a clinical problem. It has been described as a process or an outcome Young ME, Thomas A, Lubarsky S, Gordon D, Gruppen LD, Rencic J, Ballard T, Holmboe E, Da Silva A, Ratcliffe T, Schuwirth L. Mapping clinical reasoning literature across the health professions: a scoping review. BMC Medical Education. 2020 Dec;20:1-1.
Importance of Clinical Reasoning[edit | edit source]
- Promotes professional autonomy Higgs 2019
- Improves patient outcomesPillay T, Pillay M. Contextualising clinical reasoning within the clinical swallow evaluation: A scoping review and expert consultation. South African Journal of Communication Disorders. 2021;68(1):1-2.
Clinical Reasoning according to Timing[edit | edit source]
Two systems of thought are described: System 1 is instinctual and fast, whereas System 2 is methodical and deliberate (Kahneman 2011)
| System 1 | System 2 |
|---|---|
| intuitive reasoning | slow effortful thinking, deliberate |
| heuristic | useful for intentional thinking |
| intuition | slow, conscious effortful |
| pattern recognition | tends to occur in new unfamiliar situations |
| experience | tend to be reliable |
| fast, automatic | |
| can have errors and biases |
Rehabilitation professionals need to be aware of biases in automatic thinking. Crosskerry Examples of types of biases include:
- Availability bias - Priority is given to the first thought that comes to mind
- Recency bias - Give more weight to something that is recent
- Confirmation bias - Gather selective information that favours a hypothesis
- Premature closing bias - end the decision making process early and accept a diagnosis that has not been completely verified
Novice versus Expert Clinical Reasoning[edit | edit source]
Experienced clinicians use experience to develop scripts for pattern recognition
Recognition primed decision model
Rather than investigating each sign and symptom individually, the chunk information to form a pattern. This allows for a comparison of whether the current situation is similar to previous situation.
Experts rely on fast thinking until they notice that something is different
When they notice that something is different they stop, reflect on how it is different and gather more information
Novice clinicians must rely more on slow thinking because they don't have the experience to build scripts
Resources[edit | edit source]
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