DOI
https://doi.org/10.18849/ve.v5i2.283Abstract
Clinical reasoning is the process by which veterinary surgeons integrate a multitude of clinical and contextual factors to make decisions about the diagnoses, treatment options and prognoses of their patients. The brain utilises two methods to achieve this: type one and type two reasoning. Type one relies on shortcuts such as pattern-recognition and heuristics to deduce answers without involving working memory. Type two uses working memory to deliberately compute logical analyses. Both reasoning methods have sources of errors, and research has shown that diagnostic accuracy is increased when they are used together when problem-solving. Despite this, it appears unlikely that clinical reasoning ‘skill’ can be improved; instead, the most effective way to improve reasoning performance experimentally appears to be by increasing and rearranging knowledge. As yet, there is no evidence that overall clinical reasoning error can be reduced in practice.
References
Ark, T.K., Brooks, L.R. & Eva, K.W. (2006). ‘Giving Learners the Best of Both Worlds: Do Clinical Teachers Need to Guard Against Teaching Pattern Recognition to Novices?’, Academic Medicine, 81(4): 405–409. DOI: http://dx.doi.org/10.1097/00001888-200604000-00017
Baddeley, A. (2003). ‘Working memory: Looking back and looking forward’, Nature Reviews Neuroscience, 4(10): 829–839. DOI: http://dx.doi.org/10.1038/nrn1201
Charlin, B., Boshuizen, H.P.A., Custers, E.J. & Feltovich, P.J. (2007). ‘Scripts and clinical reasoning’, Medical Education, 41(12): 1178–84. DOI: http://dx.doi.org/10.1111/j.1365-2923.2007.02924.x
Cockcroft, P. (2007). ‘Clinical reasoning and decision analysis’, Veterinary Clinics of North America: Small Animal Practice, 37(3): 499–520. DOI: http://dx.doi.org/10.1016/j.cvsm.2007.01.011
Cockcroft, P. & Holmes, M. (2008). Handbook of evidence-based veterinary medicine. Wiley-Blackwell.
Coderre, S., Mandin, H., Harasym, P.H. & Fick, G.H. (2003). ‘Diagnostic reasoning strategies and diagnostic success’, Medical education, 37(8): 695–703. DOI: http://dx.doi.org/10.1046/j.1365-2923.2003.01577.x
Croskerry, P. (2009a). ‘A universal model of diagnostic reasoning’, Academic Medicine, 84(8): 1022–8. DOI: http://dx.doi.org/10.1097/ACM.0b013e3181ace703
Croskerry, P. (2009b). ‘Clinical cognition and diagnostic error: Applications of a dual process model of reasoning’, Advances in Health Sciences Education, 14(1 SUPPL): 27–35. DOI: http://dx.doi.org/10.1007/s10459-009-9182-2
Croskerry, P. & Norman, G. (2008). ‘Overconfidence in clinical decision making’, The American Journal of Medicine, 121(5): S24-9. DOI: http://dx.doi.org/10.1016/j.amjmed.2008.02.001
Croskerry, P., Petrie, D.A., Reilly, J.B. & Tait, G. (2014). ‘Deciding about fast and slow decisions’, Academic Medicine, 89(2): 197–200. DOI: http://dx.doi.org/10.1097/acm.0000000000000121
Cutrer, W., Sullivan, W. & Fleming, A. (2013). ‘Educational strategies for improving clinical reasoning’, Current Problems in Pediatric and Adolescent Health Care, 43(9): 248–57. DOI: http://dx.doi.org/10.1016/j.cppeds.2013.07.005
Dory, V., Gagnon, R. & Charlin, B. (2010). ‘Is case-specificity content-specificity? An analysis of data from extended-matching questions’, Advances in Health Sciences Education, 15(1): 55–63. DOI: http://dx.doi.org/10.1007/s10459-009-9169-z
Durning, S., Artino, A., Boulet, J., Dorrance, K., van der Vleuten, C. & Schuwirth, L. (2012). ‘The impact of selected contextual factors on experts’ clinical reasoning performance (does context impact clinical reasoning performance in experts?)’, Advances in Health Sciences Education, 17(1): 65–79. DOI: http://dx.doi.org/10.1007/s10459-011-9294-3
Eva, K. (2005). ‘What every teacher needs to know about clinical reasoning’, Medical Education, 39(1): 98–106. DOI: http://dx.doi.org/10.1111/j.1365-2929.2004.01972.x
Eva, K. & Norman, G. (2005). ‘Heuristics and biases--a biased perspective on clinical reasoning’, Medical Education, 39(9): 870–2. DOI: http://dx.doi.org/10.1111/j.1365-2929.2005.02258.x
Evans, J.S.B.T. & Stanovich, K.E. (2013). ‘Dual-Process Theories of Higher Cognition: Advancing the Debate’, Perspectives on Psychological Science, 8(3): 223–241. DOI: http://dx.doi.org/10.1177/1745691612460685
Everitt, S. (2011). Clinical Decision Making in Veterinary Practice. University of Nottingham.
Graber, M.L. (2013). ‘The incidence of diagnostic error in medicine’, BMJ Quality and Safety, 22(SUPPL.2): 21–27. DOI: http://dx.doi.org/10.1136/bmjqs-2012-001615
Graber, M.L., Franklin, N. & Gordon, R. (2005). ‘Diagnostic Error in Internal Medicine’, Archives of Internal Medicine, 165(13): 1493. DOI: http://dx.doi.org/10.1001/archinte.165.13.1493
Hatala, R., Norman, G. & Brooks, L. (1999). ‘Influence of a Single Example on Subsequent Electrocardiogram Interpretation’, Teaching and Learning in Medicine, 11(2): 110–117. DOI: http://dx.doi.org/10.1207/S15328015TL110210
Klein, J. (2005). ‘Five pitfalls in decisions about diagnosis and prescribing’, British Medical Journal, 330(7494): 781–783. DOI: http://dx.doi.org/10.1136/bmj.330.7494.781
Maddison, J.E., Volk, H.A. & Church, D.B. (2015). Clinical Reasoning in Small Animal Practice. John Wiley & Sons Ltd.
Mamede, S., Van Gog, T., Schuit, S.C.E., Van den Berge, K., Van Daele, P.L.A., Bueving, H., Van Van der Zee, T., Van den Broek, W.W., Van Saase, J.L.C.M. & Schmidt, H.G. (2017). ‘Why patients’ disruptive behaviours impair diagnostic reasoning: A randomised experiment’, BMJ Quality and Safety, 26(1): 13–18. DOI: http://dx.doi.org/10.1136/bmjqs-2015-005065
Mamede, S., Schmidt, H. & Penaforte, J. (2008). ‘Effects of reflective practice on the accuracy of medical diagnoses’, Medical Education, 42(5): 468–475. DOI: http://dx.doi.org/10.1111/j.1365-2923.2008.03030.x
May, S. (2013). ‘Clinical Reasoning and Case-Based Decision Making: The Fundamental Challenge to Veterinary Educators’, Journal of Veterinary Medical Education, 40(3): 200–209. DOI: http://dx.doi.org/10.3138/jvme.0113-008R
Van Merrienboer, J. and Sweller, J. (2010). ‘Cognitive load theory in health professional education: design principles and strategies’, Medical Education, 44(1): 85–93. DOI: http://dx.doi.org/10.1111/j.1365-2923.2009.03498.x
Norman, G. (1989). ‘The Development of Expertise in Dermatology’, Archives of Dermatology, 125(8): 1063. DOI: http://dx.doi.org/10.1001/archderm.1989.01670200039005
Norman, G. (2005). ‘Research in clinical reasoning: past history and current trends’, Medical Education, 39(4): 418–427. DOI: http://dx.doi.org/10.1111/j.1365-2929.2005.02127.x
Norman, G.R., Monteiro, S.D., Sherbino, J., Ilgen, J.S., Schmidt, H.G. & Mamede, S. (2017). ‘The Causes of Errors in Clinical Reasoning: Cognitive Biases, Knowledge Deficits, and Dual Process Thinking’, Academic Medicine, 92(1): 23–30. DOI: http://dx.doi.org/10.1097/ACM.0000000000001421
Oxtoby, C., Ferguson, E., White, K. & Mossop, L. (2015). ‘We need to talk about error: Causes and types of error in veterinary practice’, Veterinary Record, 177(17): 438. DOI: http://dx.doi.org/10.1136/vr.103331
Schmidt, H. & Rikers, R. (2007). ‘How expertise develops in medicine: knowledge encapsulation and illness script formation’, Medical Education, 41(12): 1133–1139. DOI: http://dx.doi.org/10.1111/j.1365-2923.2007.02915.x
Sherbino, J., Kulasegaram, K., Howey, E. & Norman, G. (2014). ‘Ineffectiveness of cognitive forcing strategies to reduce biases in diagnostic reasoning: A controlled trial’, Canadian Journal of Emergency Medicine, 16(1): 34–40. DOI: http://dx.doi.org/10.2310/8000.2013.130860
Shimizu, T., Matsumoto, K. & Tokuda, Y. (2013). ‘Effects of the use of differential diagnosis checklist and general de-biasing checklist on diagnostic performance in comparison to intuitive diagnosis’, Medical Teacher, 35(6). DOI: http://dx.doi.org/10.3109/0142159X.2012.742493
Slovic, P., Finucane, M., Peters, E. & MacGregor, D. (2004). ‘Risk as Analysis and Risk as Feelings: Some Thoughts about Affect, Reason, Risk, and Rationality’, Risk Analysis, 24(2): 311–322. DOI: http://dx.doi.org/10.1111/j.0272-4332.2004.00433.x
Stanovich, K.E. & Toplak, M.E. (2012). ‘Defining features versus incidental correlates of Type 1 and Type 2 processing’, Mind and Society, 11(1): 3–13. DOI: http://dx.doi.org/10.1007/s11299-011-0093-6
Thammasitboon, S. & Cutrer, W. (2013). ‘Diagnostic Decision-Making and Strategies to Improve Diagnosis’, Current Problems in Pediatric and Adolescent Health Care, 43(9): 232–241. DOI: http://dx.doi.org/10.1016/j.cppeds.2013.07.003
Vandeweerd, J., Kirschvink, N., Clegg, P., Vandenput, S., Gustin, P. & Saegerman, C. (2012). ‘Is evidence-based medicine so evident in veterinary research and practice? History, obstacles and perspectives’, The Veterinary Journal, 191(1): 28–34. DOI: http://dx.doi.org/%2010.1016/j.tvjl.2011.04.013
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