Clinical Reasoning in the Health Professions

Title Page......Page 2
Table of Contents......Page 4
Copyright......Page 27
Preface......Page 29
The Context of Clinical Reasoning......Page 31
Collaborative and Transdisciplinary Reasoning......Page 32
Reasoning Across the Professions......Page 33
Teaching Clinical Reasoning......Page 34
Learning Clinical Reasoning......Page 35
List of Contributors......Page 37
Acknowledgements......Page 46
Section 1 Understanding Clinical Reasoning......Page 47
1 Clinical Reasoning......Page 48
Understanding Clinical Reasoning......Page 49
Challenges Faced by People Engaged in Clinical Decision Making......Page 51
Challenges of Dealing With a Complex World......Page 52
Challenges in Addressing Wicked Problems and Accountability......Page 54
Challenges of Making Complex and Consequential Decisions......Page 56
Challenges in Sharing Decision-Making Processes and Outcomes......Page 61
Building Clinical Reasoning Into Curricula......Page 62
Teaching and Learning Clinical Reasoning Complexities......Page 63
Learning Something That's Not Simply Black and White......Page 64
Chapter Summary......Page 65
References......Page 66
2 Re-Interpreting Clinical Reasoning......Page 70
Re-Interpreting Clinical Reasoning......Page 71
Clinical Reasoning as an Encultured Practice......Page 74
Understanding Professional Practice Paradigms......Page 80
Clinical Reasoning and Knowing in Practice......Page 87
Pursuing Clinical Reasoning Capability......Page 95
ReDefining Clinical Reasoning as A Range of Encultured Decision-Making Capabilities......Page 99
References......Page 105
3 Multiple Spaces of Choice, Engagement and Influence in Clinical Decision Making......Page 113
Clinical Reasoning Spaces From the Inside Out......Page 114
Client Spaces......Page 115
Practitioner Spaces......Page 117
The Collaborative Problem Space of the Team......Page 118
The Knowledge-Reasoning Space of Clinical Decision Making......Page 119
Errors......Page 120
Clinical Reasoning Strategies......Page 122
Professional Development of Clinical Reasoning Capability......Page 129
Chapter Summary......Page 133
References......Page 134
4 Clinical Reasoning and Models of Practice......Page 140
Recognizing Our Practice Context and Influences......Page 141
Models of Practice......Page 147
Reasoning in a Critical Social Science Model for Practice......Page 151
References......Page 160
5 The Development of Clinical Reasoning Expertise......Page 163
A Theory of the Development of Medical Expertise......Page 164
Teaching Clinical Reasoning......Page 171
Chapter Summary......Page 177
References......Page 178
6 Expertise and Clinical Reasoning......Page 183
Introduction......Page 184
Deconstructing the Interrelated Concepts of Expertise and Clinical Reasoning......Page 185
Expertise and Clinical Reasoning in Everyday Practice......Page 191
Clinical Reasoning and Novice Development: Developing Habits of Mind......Page 196
Chapter Summary......Page 199
References......Page 200
Section 2 The Changing Context of Clinical Reasoning and Practice......Page 205
7 The Context of Clinical Reasoning Across the Health Professions in the 21St Century......Page 206
Introduction......Page 207
Shifting Contexts and Identities......Page 210
Clinical Reasoning: Valuing Evidence......Page 213
Critical Reflexivity and ‘Negotiation’......Page 216
Chapter Summary......Page 217
References......Page 218
8 Changing Demographic and Cultural Dimensions of Populations......Page 223
Introduction......Page 224
Changing Populations......Page 226
Changing Populations and Clinical Reasoning......Page 228
Clinical Reasoning in a Postindustrial World......Page 238
Conclusion......Page 239
Chapter Summary......Page 240
References......Page 241
9 Clinical Thinking, Client Expectations and Patient-Centred Care......Page 244
Current Conceptions of Client Expectations and Patient-Centred Care......Page 245
How Healthcare Professionals Think: The Central Expertise of HCPs Needs to be Better Understood by Patients......Page 248
The Importance of the Nature of the HCP's Professionalism: Uncovering Its Transformative Potential......Page 252
Chapter Summary......Page 260
References......Page 261
10 Next-Generation Clinical Practice Guidelines......Page 266
Introduction......Page 267
Frameworks of Clinical Practice Guidelines Application......Page 268
Current State of Play in Clinical Practice Guidelines......Page 269
Critical Elements of Using Clinical Practice Guidelines......Page 270
Next-Generation Clinical Practice Guidelines......Page 272
Implementation......Page 273
Clinical Practice Guidelines, Clinical Reasoning and Patient Outcomes......Page 277
The Future......Page 279
Chapter Summary......Page 280
References......Page 281
11 Action and Narrative......Page 286
Action and Judgement......Page 287
Tacit Knowledge and Professional Judgement......Page 290
Narrative Reasoning......Page 292
Prospective Stories: Therapy and Life Stories......Page 294
Active Judgements, Tacit Knowledge and Narrative Images: a Case Story......Page 297
Action, Judgement, Narrative and Expertise in Ann's Story......Page 299
Chapter Summary......Page 302
References......Page 303
12 The Language of Clinical Reasoning......Page 306
Introduction......Page 307
Metaphor......Page 309
New Metaphors in Clinical Reasoning......Page 312
Narrative......Page 314
Rhetoric......Page 315
Chapter Summary......Page 318
References......Page 319
13 Evidence-Based Practice and Clinical Reasoning......Page 322
Introduction......Page 323
Section 1: Evidence-Based Practice Is a Contributor to Clinical Reasoning......Page 327
Section 2: Evidence-Based Practice Is the Way in Which Clinical Reasoning Unfolds or Should Unfold......Page 332
Section 3: Evidence-Based Practice and Clinical Reasoning Are Different Words/Frames for the ‘Same Thing’......Page 337
References......Page 340
14 Methods in the Study of Clinical Reasoning......Page 345
Introduction......Page 346
Quantitative Methods......Page 347
Qualitative Methods......Page 352
Conclusion......Page 358
Chapter Summary......Page 359
References......Page 360
Section 3 Collaborative and Transdisciplinary Reasoning......Page 366
15 Collaborative Decision Making in Liquid Times......Page 367
New Conditions of Decision-Making Processes in Liquid Times......Page 368
Conceptual Perspectives and Principles of Collaborative Decision Making......Page 372
Conceptual Models of Shared Decision Making......Page 374
The Primacy of Interests: a Critical Model for Collaborative Decision Making......Page 375
Operationalizing Collaborative Decision Making......Page 378
References......Page 385
16 Ethical Reasoning......Page 388
Introduction......Page 389
The Ethical Reasoning Bridge......Page 392
Chapter Summary......Page 404
References......Page 405
17 Shared Decision Making in Practice......Page 410
Shared Decision Making......Page 411
Chapter Summary......Page 425
References......Page 426
18 Using Decision Aids to Involve Clients in Clinical Decision Making......Page 432
Introduction......Page 433
What Is A Patient Decision Aid?......Page 434
When Should You Consider Using a Decision Aid?......Page 435
How Do Decision Aids Work?......Page 438
What Makes a ‘Good’ Decision Aid?......Page 439
Where Can You Find Patient Decision Aids?......Page 442
What Should I Do if I Cannot Find a Relevant Decision Aid?......Page 443
How Can the Health Team Play a Role?......Page 444
Can Patient Decision Aids Be Used to Involve Family Members and Carers?......Page 445
Can Patients From Vulnerable Populations Benefit From Using Patient Decision Aids?......Page 446
Chapter Summary......Page 447
References......Page 448
19 Clinical Decision Making, Social Justice and Client empowerment......Page 454
Introduction......Page 455
Social Determinants of Health......Page 456
Social Justice......Page 461
Empowerment......Page 467
Chapter Summary......Page 469
References......Page 470
20 Clinical Decision Making Across Orthodox and Complementary Medicine Fields......Page 475
Introduction......Page 476
Alternative Ways of Thinking Through Clinical Problems......Page 479
Models of Integration......Page 483
Integrated Clinical Reasoning......Page 486
Chapter Summary......Page 489
References......Page 490
Section 4 Clinical Reasoning and The Professions......Page 495
21 Clinical Reasoning in Medicine......Page 496
Introduction......Page 497
A Common Basis: Dual-Process Theory......Page 498
Problem Solving: Diagnosis as Hypotheses Generation and Selection......Page 499
The Hypothetico-Deductive Method......Page 500
Diagnosis as Categorization or Pattern Recognition......Page 502
Multiple Reasoning Strategies......Page 503
Decision Making: Diagnosis as Opinion Revision......Page 504
A Common Challenge: Diagnostic Error......Page 506
Errors in Hypothesis Generation and Restructuring......Page 507
Errors in Data Interpretation......Page 508
Errors in Probability Estimation......Page 509
Errors in Probability Revision......Page 510
Educational Implications......Page 512
Problem Solving: Educational Implications......Page 513
Decision Making: Educational Implications......Page 514
References......Page 517
22 Clinical Reasoning in Nursing......Page 526
Introduction......Page 527
Theoretical Perspectives......Page 528
Chapter Summary......Page 545
References......Page 546
23 Clinical Reasoning in Physiotherapy......Page 552
Introduction......Page 553
Why Do Physiotherapists Need to Study and Practice Clinical Reasoning?......Page 554
Three Frameworks to Situate Clinical Reasoning in Physiotherapy......Page 559
Factors Influencing Clinical Reasoning......Page 571
References......Page 578
24 Clinical Reasoning in Dentistry......Page 586
Evolution of Clinical Reasoning......Page 587
Exploring Clinical Reasoning......Page 588
Conceptual Framework......Page 590
Processes of Clinical Reasoning......Page 591
Clinical Reasoning Strategies......Page 593
Uncertainties in Clinical Reasoning......Page 596
Assessment of Clinical Reasoning......Page 599
Chapter Summary......Page 600
References......Page 601
25 Clinical Reasoning in Occupational Therapy......Page 608
Introduction......Page 609
Clinical Reasoning in Occupational Therapy: Historical Perspective......Page 610
Knowledge and Clinical Reasoning in Occupational Therapy......Page 613
Information Processing, Cognitive Strategy Use and Clinical Reasoning......Page 622
Chapter Summary......Page 629
References......Page 630
26 Clinical Decision Making in Emergency Medicine......Page 637
Introduction......Page 638
Emergence of Dual-Process Theory in Clinical Decision Making......Page 639
Rationality in Clinical Decision Making......Page 641
Facilitators of Rationality......Page 642
Dysrationalia......Page 644
How Does CDM in Emergency Medicine Differ From That in Other Settings?......Page 652
References......Page 653
27 Clinical Decision Making in Paramedicine......Page 657
Introduction......Page 658
The Nature of Paramedic Practice......Page 659
Clinical Reasoning in Paramedicine Practice......Page 661
Cognitive Strategies Involved in Clinical Reasoning......Page 662
Errors in Clinical Reasoning......Page 664
Educational Strategies to Improve Clinical Reasoning......Page 666
Chapter Summary......Page 669
References......Page 670
28 Clinical Decision Making in Optometry......Page 673
Optometry and Its Scope of Practice......Page 674
Evidence-Based Decision Making in Optometry......Page 676
From Decision Making to Clinical Reasoning......Page 684
Conclusion......Page 687
Chapter Summary......Page 688
References......Page 689
29 Clinical Reasoning in Dietetics......Page 694
Introduction......Page 695
The Context of Dietetics......Page 696
Clinical Reasoning in Clinical Dietetics......Page 699
Collaborative Decision Making in Dietetics......Page 704
Clinical Reasoning in Advanced Dietetic Practice......Page 706
Chapter Summary......Page 710
References......Page 711
30 Clinical Reasoning in Pharmacy......Page 715
Introduction......Page 716
The Pharmacist as Part of A Collaborative Team......Page 717
Clinical Problem Solving for the Pharmacist......Page 718
Chapter Summary......Page 731
References......Page 732
Section 5 Teaching Clinical Reasoning......Page 734
31 Pedagogies for Teaching and Learning Clinical Reasoning......Page 735
What Is Clinical Reasoning?......Page 736
Embodied Nature of Clinical Reasoning......Page 738
Situated Nature of Clinical Reasoning......Page 740
Pedagogies for Teaching Clinical Reasoning......Page 741
Teaching Clinical Reasoning in Classrooms......Page 744
Teaching Clinical Reasoning in Workplaces......Page 746
Future Directions......Page 750
Chapter Summary......Page 752
References......Page 753
32 Teaching Clinical Reasoning in Medical Education Courses......Page 757
Introduction......Page 758
Understanding Reasoning......Page 759
Integration......Page 770
Introduction to Uncertainty and Diagnostic Error......Page 778
Conclusion......Page 784
References......Page 785
33 Teaching Clinical Reasoning in Nursing Education......Page 790
Providing Opportunities for Autonomous Practice......Page 791
Focussing on Deliberate Practice......Page 792
Using Higher-Order Questioning......Page 793
Emphasizing the Importance of Evidence-Based Practice......Page 795
Learning to Think Aloud......Page 796
Deconstructing Critical Events......Page 798
Reflecting on Cognitive Biases......Page 799
Chapter Summary......Page 803
References......Page 804
34 Speech-Language Pathology Students......Page 807
Introduction......Page 808
ICF as a Framework for Clinical Reasoning......Page 810
Facilitating Clinical Reasoning......Page 813
Clinical Reasoning Approaches......Page 814
ICF and Clinical Reasoning in Practice (Case Study 34.1 Analysis)......Page 817
Strong Clinical Reasoning Includes Consideration of All Areas of ICF (Case Study 34.2 Analysis)......Page 819
Strategies for Ces: Using the ICF to Extend Students’ Clinical Reasoning Skills......Page 820
Chapter Summary......Page 823
Acknowledgement......Page 824
References......Page 825
35 Clinical Reasoning and Biomedical Knowledge......Page 828
Introduction......Page 829
Curricular and Epistemological Issues......Page 830
Research in Clinical Reasoning......Page 832
Knowledge Encapsulation or Two Worlds......Page 839
Chapter Summary......Page 843
References......Page 844
36 Cultivating A Thinking Surgeon, Using A Clinical Thinking Pathway as A Learning and Assessment Process......Page 849
Introduction......Page 850
The Clinical Thinking Pathway: the Basic Components......Page 851
Key Insights From 10 Years of Work......Page 856
Crystallizing the Discourse and Offering Further Educational Resources......Page 859
Chapter Summary......Page 865
References......Page 867
37 Interprofessional Programs to Develop Clinical Reasoning......Page 872
Introduction......Page 873
Background......Page 874
Learning Outcomes......Page 875
Interprofessional Learning Activities for Clinical Reasoning......Page 876
Learning Through Structured Opportunities in the Classroom......Page 877
Learning Through Simulation......Page 878
Learning Through Community Engagement, Partnerships and Service......Page 879
Learning About Collaborative Leadership......Page 882
Challenges of IPE......Page 884
Faculty Development......Page 885
Chapter Summary......Page 887
References......Page 888
38 Assessing Clinical Reasoning......Page 892
Introduction......Page 893
Research on Decision Making......Page 895
An Historical Perspective on Assessment......Page 896
Newer Assessment Developments......Page 898
But What About Clinical Reasoning?......Page 901
Current Developments......Page 903
Implications and Advice for the Teacher......Page 904
References......Page 906
Section 6 Learning Clinical Reasoning......Page 911
39 Learning to Communicate Clinical Reasoning......Page 912
Introduction......Page 913
Communication of Clinical Reasoning......Page 914
Learning to Communicate Clinical Reasoning: What's Involved?......Page 916
Chapter Summary......Page 923
References......Page 924
40 Developing Clinical Reasoning Capability......Page 927
Capability as A Learning Outcome......Page 928
Clinical Reasoning Capability......Page 930
Future Implications......Page 936
Chapter Summary......Page 938
References......Page 939
41 Remediating Learning and Performance of Reasoning......Page 944
Can Clinical Reasoning Be Learned?......Page 945
Identification of Students Who Struggle With Clinical Reasoning......Page 946
Understanding Struggling Learners......Page 948
Unique Challenges to Learning Clinical Reasoning......Page 950
An Approach to the Remediation of Clinical Reasoning......Page 951
Using the Tools and Grids in the Clinical Environment......Page 958
Chapter Summary......Page 960
References......Page 961
42 Learning About Factors Influencing Clinical Decision Making......Page 963
Clinical Decision Making......Page 964
Acknowledgement......Page 978
References......Page 979
43 Learning Reasoning Using Simulation......Page 981
Introduction......Page 982
What Is Simulation-Based Learning?......Page 983
Facilitating Clinical Reasoning Development Through Simulation-Based Learning......Page 989
Cognitive Load Considerations for Simulation-Based Learning......Page 993
Future Implications......Page 997
Chapter Summary......Page 998
References......Page 999
44 Learning to Use Evidence to Support Decision Making......Page 1003
Understanding Evidence-Based Practice......Page 1004
What Constitutes Evidence?......Page 1007
Evidence-Based Practice and Clinical Reasoning......Page 1014
References......Page 1020
45 Learning to Research Clinical Reasoning......Page 1024
Introduction......Page 1025
Develop a Research Question......Page 1026
Identify a Conceptual Framework......Page 1027
Select the Research Designs and Methods......Page 1030
Develop the Research Design......Page 1033
Chapter Summary......Page 1038
References......Page 1039
46 Learning Clinical Reasoning Across Cultural Contexts......Page 1041
Introduction......Page 1042
Culture, Context and Professional Practice......Page 1043
What Is Cultural Competence?......Page 1045
Conclusion......Page 1053
References......Page 1054
47 Peer Learning to Develop Clinical Reasoning Abilities......Page 1057
Peer Learning for Knowledge and Metaskills Development......Page 1058
Peer Learning Activity Design Considerations......Page 1059
Facilitating Clinical Reasoning Development With Peer Learning......Page 1062
Conclusion......Page 1068
References......Page 1069
Index......Page 1072