SEARCH · PubMed Health

Results for “Clinical Reasoning”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 37 records · Page 2Linked to original sources

PubMed2002

Comparison of an aggregate scoring method with a consensus scoring method in a measure of clinical reasoning capacity.

BACKGROUND: Diversity of clinical reasoning paths of thought among experts is well known. Nevertheless, in written clinical reasoning assessment, the common practice is to ask experts to reach a consensus on each item and to assess students on a unique "good answer." PURPOSES: To explore the effects of taking the variability of experts answers into account in a method of clinical reasoning assessment based on authentic tasks: the Script Concordance Test. METHODS: Two different methods were used to build answer keys. The first incorporated variability among a group of experts (criterion experts) through an aggregate scoring method. The second was made with the consensus obtained from the group of criterion experts for each answer. Scores obtained with the two methods by students and another group of experts (tested experts) were compared. The domain of assessment was gynecology-obstetric clinical knowledge. The sample consisted of 150 clerkship students and seven other experts (tested experts). RESULTS: In a context of authentic tasks, experts' answers on items varied substantially. Amazingly, 59% of answers given individually by criterion group experts differed from the answer they provided when they were asked in a group to provide the "good answer" required from students. The aggregate scoring method showed several advantages and was more sensitive to detecting expertise. CONCLUSIONS: The findings suggest that, in assessment of complex performance in ill-defined situations, the usual practice of asking experts to reach a consensus on each item reduces and hinders the detection of expertise. If these results are confirmed by other researches, this practice should be reconsidered.

Cluster Analysis↗

PubMed1999

Differential diagnosis: a reasonable clinical approach.

The reasonable clinical approach to the patient who has low back pain includes a search for any of the red flags that would prompt consideration of additional diagnostic testing for serious underlying disease. The common patterns of back pain would be explored in an effort to categorize the patient's symptoms and to begin formulation of a diagnostic impression. Re-evaluation of the patient in light of his response (or lack of response) to these measures is an essential component of the clinical assessment. Finally, some consideration must be given to the various biopsychosocial factors that may affect prognosis, particularly in patients who have more chronic pain and disability-related issues.

Diagnosis, Differential↗

PubMed1990

Paradigm case analysis and stimulated recall: strategies for developing clinical reasoning skills.

Development of clinical reasoning skills was a major objective of a collaborative venture between a university school of nursing and a tertiary care teaching hospital. Two elective courses and an 8-month practicum were offered at the graduate level to students specializing in perinatal nursing. Through analysis of their own cases and those of clinical experts, students gained expertise in tracing the development of their decision-making skills. In the clinical practicum, where it was less feasible for the student and preceptor to withdraw from the clinical setting to discuss the decision-making process, "stimulated recall" was employed. This strategy uses segments of nurses' actual practice, on site, at the time of care delivery. In this way, the total context of the clinical reasoning process of nurses can be examined. In this paper, the two strategies are discussed with illustrations from the actual teaching/learning situations.

Decision Making↗

PubMed2004

Clinical reasoning strategies in physical therapy.

BACKGROUND AND PURPOSE: Clinical reasoning remains a relatively under-researched subject in physical therapy. The purpose of this qualitative study was to examine the clinical reasoning of expert physical therapists in 3 different fields of physical therapy: orthopedic (manual) physical therapy, neurological physical therapy, and domiciliary care (home health) physical therapy. SUBJECTS: The subjects were 6 peer-designated expert physical therapists (2 from each field) nominated by leaders within the Australian Physiotherapy Association and 6 other interviewed experts representing each of the same 3 fields. METHODS: Guided by a grounded theory method, a multiple case study approach was used to study the clinical practice of the 6 physical therapists in the 3 fields. RESULTS: A model of clinical reasoning in physical therapy characterized by the notion of "clinical reasoning strategies" is proposed by the authors. Within these clinical reasoning strategies, the application of different paradigms of knowledge and their interplay within reasoning is termed "dialectical reasoning." DISCUSSION AND CONCLUSION: The findings of this study provide a potential clinical reasoning framework for the adoption of emerging models of impairment and disability in physical therapy.

Data Collection↗

PubMed1998

Clinical reasoning case studies as teaching tools.

OBJECTIVE: Students are taught how to apply clinical reasoning methods through a variety of teaching methods, including the use of case studies. Various types of case studies have been described in the literature: paper cases, videotape cases, simulated client cases, and real client cases. This study examined the effectiveness of a new type of paper case study--the clinical reasoning case study--in teaching the clinical reasoning process to occupational therapy students. METHOD: Four seniors in an undergraduate occupational therapy program completed intervention plans in response to both traditional medical model and clinical reasoning paper case studies. Qualitative methods were used to analyze intervention plans and videotaped discussion about this learning experience. RESULTS: Themes discovered in the data sources suggest that compared with traditional case studies, the clinical reasoning case studies increased the quality of participants' intervention plans, participants' confidence levels about their plans, and participants' understanding of the clinical reasoning process. Participants also reported preferring clinical reasoning case studies over traditional paper case studies. CONCLUSION: The clinical reasoning case studies are effective teaching tools because they provide students with a holistic picture of the client and his or her occupational therapy treatment. In addition, these case studies model the clinical reasoning process by organizing client information according to the types of clinical reasoning that would be used to gather that information. Occupational therapy educators may find this type of paper case study useful in introducing students to the intervention planning process.

Female↗

PubMed1985

An analysis of the magnitude of clinical-reasoning deficiencies in one class.

Clinical-reasoning ability is indispensable to a good doctor, but students are generally expected to "pick it up" in the course of their clinical clerkships. Concern by the University of Washington School of Medicine that some students did not master the concepts of clinical reasoning led to the formation of an ad hoc committee whose retrospective study on the class of 1981 is reported here by the authors. Nineteen students (11 percent of the graduating class) who were repeatedly noted by faculty members to have problems with clinical reasoning throughout their clinical clerkships were identified as a result of this study.

Achievement↗

PubMedDate not supplied

Registered nurses' clinical reasoning abilities: a study of self perception.

Effective clinical reasoning by nurses is an essential component of nursing practice. The purpose of this study was to gain increased awareness and insight into registered nurses' perception of their clinical reasoning ability. A convenience sample of post-registration nursing students (n = 520) who enrolled in a Bachelor of Nursing program from 1993 to 1996 participated in the study. Perceptions of clinical reasoning abilities were assessed using the Jenkins' Clinical Decision Making in Nursing Scale (CDMNS). Analysis of CDMNS total scores indicated these students entered the program with positive perceptions of how they go about making clinical decisions. Measurement of aspects of these perceptions in relation to searching for alternatives (Subscale A), canvassing objectives (Subscale B) and evaluating consequences (Subscale C) indicated moderately positive perceptions of clinical reasoning abilities. However, highly positive perceptions were evident for assimilating new information (Subscale D). These results indicate some dissonance between the perceived abilities and the actual abilities reported in clinical reasoning literature and frequently observed in practice.

Clinical Competence↗

PubMedDate not supplied

Missed diagnosis of amoebic liver abscess: a case for forward clinical reasoning.

BACKGROUND: Increasingly, a wrong diagnosis is made and wrong investigations and treatment ordered, because the doctor uses one or two symptoms to jump into a premature conclusion, without consideration of the totality of a patient's presentation. This is not forward clinical reasoning. Forward clinical reasoning is based on a systematic approach to patient's problems. The objective of this paper is to use a real case to illustrate the pitfall in ignoring forward clinical reasoning and how forward clinical reasoning serves the physician's and patient's interest better. METHOD/RESULT: The case of a 3 year old who had amoebic liver abscess but was wrongly diagnosed and treated for lobar Pneumonia with pleural effusion is highlighted. The sequence for forward clinical reasoning is used to show how the right diagnosis could have been arrived at. CONCLUSION: The correct diagnosis following sequential forward clinical reasoning saves time, money and life.

Child, Preschool↗

PubMed2003

Physical therapy students' self-reports of development of clinical reasoning: a preliminary study.

Reports of student perceptions about the efficacy of educational tools used by academic and clinical instructors to facilitate clinical reasoning are limited. Physical therapist students' (PTSs') perceptions of tools for developing clinical reasoning and problem-solving skills were surveyed to determine the effectiveness of various teaching methods and to identify factors associated with clinical reasoning development. The purposes of this descriptive investigation were to determine (1) if factors, such as learning mode, life experience, and curriculum, influence PTS' perception of their clinical reasoning mastery; (2) the relative roles of academic and clinical instructors and the value of their pedagogic tools in assisting PTS with clinical reasoning development; and (3) how PTS rate their degree of mastery of clinical reasoning as they progress through training. A survey was mailed to 17 physical therapy schools in New York and 2 in New Jersey; 156 PTS near graduation responded, yielding a 22% response rate. The survey instrument had 6 open-ended and 19 multiple-choice questions. Frequency analysis showed (1) PTS' opinion about how they would teach clinical reasoning varied with their preferred learning mode, (2) prior life experiences were associated with clinical reasoning for some individuals, (3) academic and clinical instructors contribute to development of clinical reasoning, (4) the best pedagogic tools involved case study presentations/ assignments using actual patients or videotapes, and (5) PTS gained confidence in their clinical reasoning ability while progressing through clinical education experiences. Results support inclusion of diverse pedagogic tools, such as case studies, and emphasizing a variety of learning modes to facilitate PTS' development of clinical reasoning.

Allied Health Personnel↗

PubMedDate not supplied

Strengthening clinical reasoning in graduate nursing students.

Clinical reasoning skills are the cornerstone of successful nursing practice. To strengthen the clinical reasoning skills of graduate nursing students, faculty at one university developed an innovative course focusing on theoretical knowledge about clinical decision making and reflective exercises to foster student thinking.

Clinical Competence↗

PubMed2002

Improving oral presentation skills with a clinical reasoning curriculum: a prospective controlled study.

PURPOSE: The oral case presentation is an essential part of clinical medicine, but teaching medical students to present clinical data remains difficult. Presentation skills depend on the ability to obtain, process, and organize patient data. Clinical reasoning is fundamental to the development of these skills. We compared a clinical reasoning curriculum with standard ward instruction for improving presentation skills and clinical performance. SUBJECTS AND METHODS: Between October 1998 and May 1999, 62 third-year medical students at three hospitals were assigned to a 4-week clinical reasoning curriculum (n = 27) or a control group (n = 35) that underwent routine instruction. The curriculum consisted of four 1-hour group sessions and 1 hour of individual videotaped instruction, and taught students to use the principles of clinical reasoning, such as generation and refinement of diagnostic hypothesis, interpretation of diagnostic tests, and causal reasoning, to determine data for inclusion in the oral presentation. We videotaped students presenting two standardized case histories; one at baseline and a second 4 weeks later. Two independent evaluators who were blinded to the group assignments reviewed the videotapes and scored them for presentation quality and efficiency, and general speaking ability. RESULTS: Mean (+/- SD) presentation times at baseline were similar in the two groups (intervention group: 8 +/- 2 minutes; control group: 8 +/- 2 minutes; P = 0.74). Presentation time in students who were taught clinical reasoning decreased by 3 +/- 2 minutes, but increased by 2 +/- 2 minutes in control students. The difference in the changes between the groups was statistically significant (mean difference = 4 minutes; 95% confidence interval [CI]: 3 to 5 minutes; P <0.001). Presentation quality scores at baseline were similar in both groups (intervention group: 17 +/- 8 points; control group: 20 +/- 7 points; P = 0.11). Students who were taught the clinical reasoning curriculum had an improvement of 9 +/- 6 points in the quality of their presentations, while control students had an improvement of 2 +/- 7 points (on a scale of 4-36). The difference in the changes between the groups was statistically significant (mean difference = 4 points; 95% CI: 1 to 7 points; P = 0.04). CONCLUSION: A clinical reasoning curriculum, in combination with video-based individual instruction, improves the efficiency and quality of oral presentations, and may augment clinical performance.

Adult↗

PubMed1996

Teaching strategies for the development of clinical reasoning.

A primary aim of occupational therapy education is to teach students how to think like practitioners, that is, how to engage in clinical reasoning. Since the early 1980s, occupational therapy clinical reasoning research has elucidated a language that describes the various types of thinking therapists use in clinical practice, a language that has the potential to make previously tacit thought processes accessible to conscious examination and improvement. Occupational therapy educators can use that language to make their teaching of clinical reasoning more explicit to students. This article examines occupational therapy teaching methods using the language of clinical reasoning, categorizing them by the types of clinical reasoning they promote. Current clinical reasoning language is reviewed, and teaching strategies to facilitate the various types of clinical reasoning are described.

Decision Making↗

PubMed1995

Using the case method to develop clinical reasoning skills in problem-based learning.

Clinical reasoning is increasingly recognized as a crucial component of the occupational therapy process. Different types of clinical reasoning used by occupational therapists have been identified, including scientific, procedural, interactive, narrative, conditional, and pragmatic reasoning. This article describes the use of the case method in the University of New Mexico undergraduate occupational therapy curriculum to facilitate development of occupational therapy students' problem-solving and reasoning abilities. The case method is a component of problem-based learning that emphasizes small group work to solve clinical problems that are presented as case studies. Students are presented with a variety of case formulas including paper or written cases, videotape cases, simulated client cases, and real client cases to promote the development of specific types of clinical reasoning. Problem-based learning may also hold promise as an educational strategy for fieldwork students and clinicians.

Curriculum↗

PubMed1991

Occupational therapy diagnostic reasoning: a component of clinical reasoning.

The occupational therapy process involves the assessment and treatment of problems in occupational status. Assessment entails the sensing and defining of patients' problems and is accomplished through diagnosis. As a process, diagnosis involves the creation of a clinical image of the patient through cue acquisition, hypothesis generation, cue interpretation, and hypothesis evaluation. This sequence of cognitive activities is called diagnostic reasoning. As a product, diagnosis summarizes a patient's occupational deficits in terms of occupational role performance, occupational performance, and the components of occupational performance. To serve adequately as a basis for planning intervention, the occupational therapy diagnosis describes the problem, explains the potential cause of the problem, gives the cues whereby the problem is recognized, and names the pathologic agent. Occupational therapy assessment is broader than diagnosis and includes a delineation of the patient's assets as well as deficits. In the resolution of problems in occupational status, assets may be used to offset deficits. The clinical image represents a balanced view of occupational status by reflecting assets and deficits.

Clinical Competence↗

PubMed2005

Teaching medical students the important connection between communication and clinical reasoning.

BACKGROUND: Medical students are rarely taught how to integrate communication and clinical reasoning. Not understanding the relation between these skills may lead students to undervalue the connection between psychosocial and biomedical aspects of patient care. OBJECTIVE: To improve medical students' communication and clinical reasoning and their appreciation of how these skills interrelate in medical practice. DESIGN: In 2003, we conducted a randomized trial of a curricular intervention at Johns Hopkins University School of Medicine. In a 6-week course, participants learned communication and clinical reasoning skills in an integrative fashion using small group exercises with role-play, reflection and feedback through a structured iterative reflective process. PARTICIPANTS: Second-year medical students. MEASUREMENTS: All students interviewed standardized patients who evaluated their communication skills in establishing rapport, data gathering and patient education/counseling on a 5-point scale (1=poor; 5=excellent). We assessed clinical reasoning through the number of correct problems listed and differential diagnoses generated and the Diagnostic Thinking Inventory. Students rated the importance of learning these skills in an integrated fashion. RESULTS: Standardized patients rated curricular students more favorably in establishing rapport (4.1 vs 3.9; P=.05). Curricular participants listed more psychosocial history items on their problem lists (65% of curricular students listing > or =1 item vs 44% of controls; P=.008). Groups did not differ significantly in other communication or clinical reasoning measures. Ninety-five percent of participants rated the integration of these skills as important. CONCLUSIONS: Intervention students performed better in certain communication and clinical reasoning skills. These students recognized the importance of biomedical and psychosocial issues in patient care. Educators may wish to teach the integration of these skills early in medical training.

Clinical Competence↗

PubMed2003

Clinical reasoning. What is its nature? Can it be taught?

Clinical reasoning constitutes the core of medical practice, being the structural basis that defines the clinician as an expert. The common conviction--mostly among health care managers and politicians--that medicine is above all a scientific endeavor, and therefore all clinical decisions must be based exclusively on scientific evidence, is limited and does not take into account the inescapable need for clinical judgement in all its practical facets. The old saying "medicine is an art as well as a science" emphasizes the need to integrate the methodology of evidence-based medicine (EBM) with the methodology of the arts and humanities, seeking a medical praxis that satisfies patients as well as doctors. Clinical reasoning, as a crucial tool for medical practice, should be the subject of ongoing learning during medical school, post-graduation and continuing medical education. The teaching of clinical reasoning--in diagnosis, therapeutics and prognosis--requires from teachers an understanding of its two main aspects: its intrinsic nature and its development from novice to expert. This article discusses the nature of clinical reasoning, its evolution from student to medical specialist and its practical teaching.

Decision Making↗

PubMed1993

A programme for developing clinical reasoning skills in graduate physiotherapists.

This paper presents a clinical reasoning course for postgraduate physiotherapy students, conducted at the University of Sydney. The course was designed to foster the development of students' clinical reasoning skills and clinical knowledge. The rationale and nature of the course are discussed, along with evaluation findings. Results indicate that the course has succeeded in stimulating students' interest and enjoyment in clinical reasoning and promoting students' understanding of and competence in this complex ability.

Australia↗

PubMed2005

A new methodology for teaching clinical reasoning skills: problem solving clinical seminars.

In the final year of the medical curriculum of the Faculty of Medicine of the Katholieke Universiteit Leuven (Belgium), a new methodology for teaching clinical skills was introduced: Problem Solving Clinical Seminars (PSCS). Two eight-week series of 70 seminars were offered. Students prepared for the seminars in groups of five students who worked on one or more clinical cases followed by half-open questions. Additional information was collected individually. At the clinical seminar the solutions were presented and discussed, guided by a clinical teacher. A questionnaire was administered to investigate whether students perceive the new type of clinical seminars as a powerful learning environment. Students were satisfied with the new methodology. The importance of the postulated educational aspects--preparation, clinical case and the seminar--was confirmed. The preparation phase (self-study and group work) and the clinical seminar were experienced as two separate and important learning events. The implementation of the problem solving clinical seminars is considered by students to be a powerful learning environment and therefore a broader applicability of the PSCS methodology is recommended.

Belgium↗