Clinical Reasoning Research Papers - Academia.edu (original) (raw)

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- Nursing, Self Care, Clinical Reasoning, Teaching
- by Anna Brugnolli
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- Nursing, Reflective Practice, Critical Thinking, Clinical Reasoning

Narrative reasoning is a central mode of clinical reasoning in occupational therapy. Therapists reason narratively when they are concerned with disability as an illness experience, that is, with how a physiological condition is affecting a person’s life. In this paper, narrative reasoning is contrasted with propositional reasoning, and two kinds of narrative thinking are examined. The first is the use of narrative as a mode of speech that can be contrasted with biomedical discourse, in which disability is framed as physical pathology. The second involves the creation rather than the telling of stories. Therapists try to “emplot” therapeutic encounters with patients, that is, to help create a therapeutic story that becomes a meaningful short story in the larger life story of the patient.

- by Cheryl Mattingly
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- Communication, Creativity, Occupational Therapy, Imagination
- by Daniel Pesut
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- Nursing, Clinical Reasoning, Learning, Thinking
- by Jan Gwyer and +1
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- Decision Making, Research Design, Grounded Theory, Clinical Reasoning
- by Wellesley Foshay
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- Bioinformatics, Life Sciences, Clinical Reasoning, Problem Solving
- by Ann Moore
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- Complementary and Alternative Medicine, Clinical Reasoning, Manual Therapy, Osteopathy
- by Tammy Hoffmann
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- Nursing, Evidence Based Practice, Health Education, Clinical Reasoning

To analyze the degree to which standardized nursing language was used by baccalaureate nursing students completing Outcome-Present State-Test (OPT) model worksheets in a clinical practicum. METHODS. A scoring instrument was developed and 100 worksheets were retrospectively analyzed. NANDA nursing diagnoses were correctly stated in 92% of the OPT models. Nursing Outcomes Classification (NOC) outcomes were explicitly stated in 22%, and implied in 72%. Interventions matched appropriate Nursing Interventions Classification (NIC) activities in 61%. NANDA, NIC, and NOC (NNN) language was used inconsistently by students in this sample. If NNN language is to advance nursing knowledge, its promotion, representation in curriculum development, and active use is necessary. Educational research is needed on the facilitators and barriers to NNN language use.

- by Daniel Pesut
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- Nursing, Logic, Documentation, Clinical Reasoning
- by Michele Groves
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- Logic, Australia, Clinical Reasoning, Thinking

El presente documento expone el caso práctico: Impacto del Aprendizaje Basado en Problemas (ABP de aquí en adelante) en el razonamiento clínico de alumnos del 6º cuatrimestre de la Licenciatura en Nutrición en el período Mayo– Diciembre 2015 de la Universidad de Estudios Profesionales de Ciencias y Artes de León, Gto, el cual da respuesta a la problematización de la enseñanza y aprendizaje del razonamiento clínico ante el contexto actual de la Docencia Superior

... Medical problem solving: An analysis of clinical reasoning. Post a Comment. CONTRIBUTORS: ... VOLUME/EDITION: PAGES (INTRO/BODY): xvi, 330 p. SUBJECT(S): Medical logic; Medicine; Problem solving; Diagnosis; Decision making.... more

- by Arthur S Elstein
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- Clinical Reasoning, Problem Solving

Objective This paper aims to summarise the evidence supporting the role of experience-based, non-analytic reasoning (NAR) or pattern recognition as a central feature of expert medical diagnosis.Methods The authors examine a series of studies, primarily from their own research programme at McMaster University, that demonstrate that expert and novice diagnostic problem solving is based, to some degree, on similarity to a prior specific exemplar in the memory.Results The studies reviewed have shown NAR to be a component of diagnostic reasoning at all levels from novice to subspecialist, and in dermatology, electrocardiography and psychiatry. The retrieval process is rapid and is not available to retrospection. It may be based on visual similarity, but can also be present in verbal descriptions. Some evidence exists that the process is unlikely to be available to introspection. Further, early hypotheses based on NAR can result in the reinterpretaton of critical clinical findings.Conclusions Non-analytic reasoning is a central component of diagnostic expertise at all levels. Clinical teaching should recognise the centrality of this process, and aim to both enhance the process through the learning of multiple examples and to supplement the process with analytical de-biasing strategies.

- by Lee Brooks
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- Education, Decision Making, Medical Education, Clinical Reasoning
- by Mark Young
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- Cognition, Information Integration, Clinical Reasoning, Anchoring
- by Virginia Strand and +3
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- Social Work, Mental Health, Evidence Based Practice, Problem Based Learning

Expressive assessments facilitate sharing, and the therapeutic understanding of youth. The experiences of nine young adults seeking help for psychosis were explored with an arts-based, occupational therapy expressive evaluation. The study used participant-observation methods. Data analysis drew on hermeneutic phenomenology. The findings illustrate the challenges these participants have in feeling connected to a shared world of doing, and in locating themselves within the temporal flow of time. Of significance was the potential to read the unfolding of creation in clay media as an acted narrative to tap into ‘constellations of meaning’. Implications for clinical practice and professional reasoning are highlighted.

- by Hiba Zafran, PhD. and +3
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- Occupational Therapy, Expressive Arts Therapy, Hermeneutics and Narrative, Hermeneutic Phenomenology
- by Nabishah Mohamad
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- Decision Making, Medical Education, Clinical Reasoning, Communication Skill

The purpose of this qualitative study was to identify the dimensions of clinical expertise in physical therapy practice across 4 clinical specialty areas: geriatrics, neurology, orthopedics, and pediatrics. Subjects were 12 peer-designated expert physical therapists nominated by the leaders of the American Physical Therapy Association sections for geriatrics, neurology, orthopedics, and pediatrics. Guided by a grounded theory approach, a multiple case study research design was used with each of the 4 investigators studying 3 therapists working in one clinical area. Data were obtained through nonparticipant observation, interviews, review of documents, and analysis of structured tasks. Videotapes made during selected therapist-patient treatment sessions were used as a stimulus for the expert therapist interviews. Data were transcribed, coded, and analyzed through the development of 12 case reports and 4 composite case studies, one for each specialty area. A theoretical model of exper...

- by Jan Gwyer
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- Decision Making, Research Design, Grounded Theory, Clinical Reasoning
- by Tazim Virani
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- Nursing, Primary Health Care, Evidence Based Practice, Health Education
- by Samuel Lapkin
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- Nursing, English language, Critical Thinking, Clinical Reasoning

There is limited understanding of how osteopaths make decisions in relation to clinical practice. The aim of this research was to construct an explanatory theory of the clinical decision-making and therapeutic approaches of experienced osteopaths in the UK. Twelve UK registered osteopaths participated in this constructivist grounded theory qualitative study. Purposive and theoretical sampling was used to select participants. Data was collected using semi-structured interviews which were audio-recorded and transcribed. As the study approached theoretical sufficiency, participants were observed and video-recorded during a patient appointment, which was followed by a video-prompted interview. Constant comparative analysis was used to analyse and code data. Data analysis resulted in the construction of three qualitatively different therapeutic approaches which characterised participants and their clinical practice, termed; Treater, Communicator and Educator. Participants' therapeutic approach influenced their approach to clinical decision-making, the level of patient involvement, their interaction with patients, and therapeutic goals. Participants' overall conception of practice lay on a continuum ranging from technical rationality to professional artistry, and contributed to their therapeutic approach. A range of factors were identified which influenced participants' conception of practice. The findings indicate that there is variation in osteopaths' therapeutic approaches to practice and clinical decision-making, which are influenced by their overall conception of practice. This study provides the first explanatory theory of the clinical decision-making and therapeutic approaches of osteopaths.

- by Dr Oliver Thomson and +1
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- Grounded Theory, Clinical Reasoning, Clinical Decision-Making, Manual Therapy

Een wetenschapsfilosofische onderbouwing van het gebruik en aanscherpen van professionele intuitie, vooral voor artsen en therapeuten. Geschreven samen met Majella van Maaren MD en met bijdragen van enkele andere artsen. Zie ook... more

Een wetenschapsfilosofische onderbouwing van het gebruik en aanscherpen van professionele intuitie, vooral voor artsen en therapeuten.
Geschreven samen met Majella van Maaren MD en met bijdragen van enkele andere artsen.
Zie ook www.bolkscompanions.com

- by Maurits in 't Veld
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- Clinical Reasoning, Phenomenology Of Intuition, Goetheanismus

Ce manuel est destiné aux rééducateurs, aux médecins généralistes et de toutes les spécialités, ainsi qu’aux patients qui cherchent désespé-rément une solution à leur douleur. La méthode de rééducation sensitive diminue les douleurs... more

- by Marion VITTAZ and +2
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- Physiotherapy, Neurology, Rheumatology, Surgery
- by elizabeth chin
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- Nursing, Clinical Reasoning, Nursing Process, Decision support system

This is the front matter and first chapter of an anthology collection of best practices in the training of clinical reasoning. Invited authors are all published researchers who train clinical reasoning skills in the health sciences. Here... more

- by Noreen Facione and +1
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- Health Sciences, Clinical Reasoning

The Concepts and Theoretical View on Teaching
Clinical Reasoning
Hsin-Hung Lin, Chin-Yun Hsu
Abstract: “Reasoning” originates from philosophy. According to its Greek origin, “reasoning” is the art of thinking, which is an analysis of thoughts for educated persons engaged in theoretical or practical activities. A "thesis" (or conclusion) is derived from a set of "premise" through a process of logical reasoning deduction (logos). Similarly, clinical reasoning is a process in which physicians utilize logical hypotheses, reasoning and testing based on patient’s clinical information to establish diagnoses in everyday practice. A physician’s proficiency is best demonstrated by the exercise of effective and efficient clinical reasoning. An integrated educational program for teaching clinical reasoning is still under development. In this article, we describe the current concepts of clinical reasoning, review the history of understanding clinical reasoning including 3 periods of prevailing hypothesis. Important theories of clinical reasoning based on modern cognitive and psychological sciences are summarized and presented. It is suggested that understanding today’s key theories of clinical reasoning including “cognitive load, dual process cognition and situated cognition” will enhance clinical reasoning abilities for learners of all levels and clinicians. This article will also provide guidance to apply theory to teach clinical reasoning effectively.
Key Words: reasoning, clinical reasoning, hypothesis, diagnosis, clinical education

- by Claudia Hsu 徐金雲 and +1
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- Clinical Reasoning

Inter-professional education that begins in undergraduate or graduate-entry programs has been accepted by universities as a proven method for fostering collaborative practice among health professionals yet there are few truly... more

- by Tammy Hoffmann
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- Nursing, Evidence Based Practice, Health Education, Clinical Reasoning
- by Danielle Noble
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- Clinical Reasoning

Clinical reasoning is essential in physical therapy practice. Instrumental approaches and more recent narrative approaches to clinical reasoning guide physical therapists in their understanding of the patient's movement disturbances and help them to plan strategies to improve function. To the extent that instrumental and/or narrative models of clinical reasoning represent impairments as mere physical disturbances, we argue that such models remain incomplete. We draw on a phenomenologically inspired approach to embodied cognition (termed ''enactivism'') to suggest that the dynamics of lived bodily engagement between physical therapist and patient contribute to and help to constitute the clinical reasoning process. This article outlines the phenomenologically informed enactive perspective on clinical reasoning, with special reference to clinical work that addresses impairments as sequelae of neurological diseases.

- by Shaun Gallagher and +1
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- Phenomenology, Body Image, Clinical Reasoning, Physical Therapy
- by Kerry Hoffman and +3
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- Nursing, Logic, Nurse Education, Clinical Reasoning
- by Ruben Tovar Ochovo
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- Clinical Reasoning

The present study investigated the influence of positive affect on clinical reasoning among practicing physicians using a simulated patient protocol. Forty-four internists were randomized to one of three groups; a control group, an affect-induction group, in which they received a small package of candy, or a group that was asked to read humanistic statements regarding the practice of medicine. Physicians “thought aloud” while they solved a case of a patient with liver disease. Two raters reviewed the transcripts to determine how soon the liver disease domain was considered, or at what point it was established, and the degree of anchoring displayed (distortion or inflexibility in thinking). The Affect group initially considered the diagnosis of liver disease significantly earlier in the protocol (20 vs 39%, or 19% earlier; 95% confidence interval; 6 to 32%,p= .008) and showed significantly less anchoring than did controls (means of 1.5 vs 3.9, or a difference of 2.4 in a scale of 1 to 10; 95% confidence interval; 0.3 to 4.5,p= .031). The Affect and Control groups established the diagnosis at similar points in the protocol. Ancillary analyses examined questions relevant to the amounts of heuristic processing, premature closure, jumping to a diagnosis without sufficient evidence, or other evidence of superficial or flawed processing. No other differences were found. Physicians in whom positive affect had been induced integrated information earlier (considered liver) and demonstrated less anchoring, but did not show evidence of premature closure or other superficial processing.

- by Carlos Estrada
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- Cognition, Information Integration, Clinical Reasoning, Anchoring

Asthma is a disease characterized by wide variations in
pathogenesis that cause resistance to flow in intrapulmonary
airways. The dramatic changes in the architecture of the airway
walls are usually connected to allergic reaction or other forms of
hyper sensitivity, causing marked spasms that lead to difficulty in
breathing. It is possible to relieve or remove the symptoms in the
majority of patients by adopting the clinical guidelines for
pharmacotherapy of asthma which include inhaled corticosteroids,
long and short acting beta agonists, muscarinic antagonists,
leukotriene modifiers, xanthine drugs and some allergy medicines.
The proper use of these agents can aid in reducing or reversing
many symptoms of asthma. Certain methods of using medicines,
for example the correct use of the inhaler for relief and
maintenance therapy, are also associated with a significant
reduction in symptoms. This can be achieved by a pharmacist’s
intervention that can provide a detailed understanding of the
current rational drug choices and proper medication use to the
patient. Nowadays massive resources are being ploughed into
research in a concerted effort to halt the progress of this illness
that can strike in all ages.

- by Bernard Charlin
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- Education, Decision Making, Medical Education, Clinical Reasoning
- by G Bordage and +2
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- Medical Education, Clinical Reasoning, Literature Review, Clinical Competence

This paper explores the assertion that much of clinical diagnostic thinking is based on the rapid and unconscious matching of the presenting problem to a similar, previously encountered, problem. This ‘non-analytic’ form of concept formation has been described in the psychology literature for over a decade. From this theory, we deduce and test several hypotheses: 1) Diagnosis is based in part on similarity to a particular previous example. In studies in dermatology, specific similarity accounts for about 30% of diagnosis. 2) When experts err, these errors are as likely as novices to occur on typical presentations. For residents, general practitioners and dermatologists, about 40% of errors were on typical slides. 3) Features are re-interpreted in light of diagnostic hypotheses. In radiology, attaching a standard positive history to the film bag increased the number of features seen on both normal and abnormal films by about 50%. 4) Experts cannot predict errors of other experts. In dermatology, experts predicted only 11–60% of errors committed by their colleagues. We conclude that amassing prior instances is an important component of expertise, and education should recognize this element.

- by Lee Brooks
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- Clinical Reasoning, Concept Formation, Prediction error, General practitioner
- by Deirdre Barrett
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- Philology, Neuroscience, Psychology, Abnormal Psychology

Le raisonnement clinique est complexe et son développement demeure méconnu, car les études portent principalement sur le processus cognitif de l'expert. Le but de l'étude doctorale est d'explorer le développement du raisonnement clinique d'étudiants selon une perspective multidimensionnelle et longitudinale en prenant appui sur un modèle multidimensionnel du raisonnement clinique et le concept de compétence. Les questions de recherche sont : 1) quelles dimensions du raisonnement clinique se manifestent chez l'étudiant? 2) quelles étapes de développement est-il possible de repérer? Il s'agit d'une étude de cas multiples explorant le développement de cinq dimensions : « Représentation », « Processus », « Métacognition », « Connaissances » et « Structures ». Quatre étudiants furent rencontrés à quatre moments entre la fin de leur formation préclinique et le début de leur formation clinique (12 mois). Chaque étudiant réalisait 1) une entrevue médicale avec un patient standardisé; 2) un entretien d'explicitation à partir d'une vidéo; 3) une carte cognitive et 4) une entrevue semi-dirigée. Des analyses intracas puis intercas furent réalisées suivant les étapes de condensation des données, de présentation des résultats et d'élaboration des conclusions. L'analyse en profondeur a permis de conclure que les cinq dimensions du raisonnement clinique sont présentes chez les étudiants dès la fin de leur formation préclinique et qu'il existe une interdépendance entre ces dimensions. De plus, cinq transformations témoignent du développement du raisonnement clinique chez l'étudiant, soit 1) l'automatisation et l'adaptation des connaissances procédurales reliées à la démarche de la collecte d'informations; 2) le déplacement de la cible de la régulation; 3) le passage d’une recherche de cohérence entre les signes et les symptômes à l’évaluation des hypothèses; 4) le passage du recours aux connaissances biomédicales à l’utilisation marquée des connaissances cliniques et 5) l’émergence de scripts. Ces transformations témoignent de deux grandes étapes de développement. Il s’agit de 1) l’intégration de la démarche de la collecte d’informations ainsi que 2) du passage d’une démarche de compréhension à une démarche de catégorisation. S’inscrivant dans l’interrelation recherche-formation-pratique, les conclusions et la méthodologie de la présente étude invitent à poursuivre l’exploration du développement du raisonnement clinique chez l’étudiant en médecine ainsi que dans d’autres domaines de la santé.

- by Annick Bourget
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- Expertise, Clinical Reasoning, Cognitive Mapping, Semi-Structured Interviews

The scientific concepts, methodologies and tools in the Knowledge Representation (KR) sub-domain of applied Artificial Intelligence (AI) came a long way with enormous strides in recent years. The usage of domain conceptualizations that are Ontologies is now powerful enough to aim at computable reasoning over complex realities.
One of the most challenging scientific and technical human endeavors is the daily Clinical Practice (CP) of Cardiovascular (CV) specialty healthcare providers.
Such a complex domain can benefit largely from the possibility of clinical reasoning aids that are now at the edge of being available.
We research into a complete end-to-end solid ontological infrastructure for CP knowledge representation as well as the associated processes to automatically acquire knowledge from clinical texts and reason over it.

- by David Mendes
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- Ontology, Social Care For Older People, Public Health, Clinical Reasoning

Medical diagnosis is a categorization task that allows phy- sicians to make predictions about features of clinical sit- uations and to determine appropriate course of action. The script concept, which first arose in cognitive psy- chology, provides a theoretical framework to explain how medical diagnostic knowledge can be structured for di- agnostic problem solving. The main characteristics of the script

- by Bernard Charlin
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- Logic, Medical Education, Clinical Reasoning, Research

Introduction: At the present time, four tests including key features, clinical reasoning, puzzle, and scenario writing are among the most well-known tests frequently used in training and assessing medical students. Medical Students who are spending their internship are the main targets of the clinical reasoning tests. Research has shown that, in terms of expertise level, the mental scripts of this group of students are categorized as intermediate (compared to two levels of students and residents). That is, different forms of tasks could activate different aspects of their mental scripts. The purpose of this study is to investigate the script-based reasoning of the intermediate group when facing different clinical reasoning tests and compare it with the reasoning of the expert and novice groups.

- by Alireza Monajemi
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- Cognitive Psychology, Clinical Reasoning
- by Daniele Chiffi
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- Bioethics, Philosophy of Medicine, Clinical Reasoning, Medical Epistemology
- by Darren Beales
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- Coping Strategies, Case Studies, Motor Control, Clinical Reasoning