Clinical Reasoning
Key Points:
- Deductive reasoning, using a few facts to generate a differential diagnosis, is typically used in medicine.
- Inductive reasoning, creating a basic hypothesis before creating a differential diagnosis, is typically used by engineers and is less susceptible to cognitive biases.
- Evidence-based medicine overlaps both inductive and deductive reasoning.
- Numerous cognitive biases may cause errors in clinical thinking.
Objectives:
- Foster critical thinking skills in learners
- Apply awareness of cognitive processes, attitudes, and skills to improve critical thinking
- Avoid pitfalls in cognitive biases
Recommended Resources:
Brief Review
Watch
♥A Guide to Clinical Reasoning: How to Create an Accurate Differential Diagnosis from a Patient's Presentation (Part 1 of 3). Eric strong. 24 minutes.
https://youtu.be/qKrLPY_8Cyk
♥A Guide to Clinical Reasoning: How to Create an Accurate Differential Diagnosis from a Patient's Presentation (Part 2 of 3). Eric strong. 31 minutes.
https://youtu.be/iEbonwYPNVk
♥A Guide to Clinical Reasoning: How to Create an Accurate Differential Diagnosis from a Patient's Presentation (Part 3 of 3). Eric strong. 27 minutes.
https://youtu.be/n48zY7GLqc0
The Necessity for Clinical Reasoning in the Era of Evidence-Based Medicine. Mayo Proceedings. 6 minutes.
http://youtu.be/Az8iQPa5VGk
Read
Papp KK, Huang GC, Lauzon Clabo LM, Delva D, Fischer M, Konopasek L, Schwartzstein RM, Gusic M. Milestones of critical thinking: a developmental model for medicine and nursing. Acad Med. 2014 May;89(5):715-20. doi: 10.1097/ACM.0000000000000220. Review. PubMed PMID: 24667504
http://www.ncbi.nlm.nih.gov/pubmed/24667504
Huang GC, Newman LR, Schwartzstein RM. Critical thinking in health professions education: summary and consensus statements of the Millennium Conference 2011. Teach Learn Med. 2014;26(1):95-102. doi:10.1080/10401334.2013.857335. PubMed PMID: 24405353
http://www.ncbi.nlm.nih.gov/pubmed/24405353
Audétat MC, Dory V, Nendaz M, Vanpee D, Pestiaux D, Junod Perron N, Charlin B. What is so difficult about managing clinical reasoning difficulties? Med Educ. 2012 Feb;46(2):216-27. doi: 10.1111/j.1365-2923.2011.04151.x. PubMed PMID: 22239335
http://www.ncbi.nlm.nih.gov/pubmed/22239335
Dhaliwal G. A piece of my mind. The mechanics of reasoning. JAMA. 2011 Sep 7;306(9):918-9. doi: 10.1001/jama.2011.1027. PubMed PMID: 21900128
http://www.ncbi.nlm.nih.gov/pubmed/21900128
Daley BJ, Torre DM. Concept maps in medical education: an analytical literature review. Med Educ. 2010 May;44(5):440-8. doi:10.1111/j.1365-2923.2010.03628.x. Epub 2010 Mar 30. Review. PubMed PMID: 20374475
http://www.ncbi.nlm.nih.gov/pubmed/20374475
Bowen JL. Educational strategies to promote clinical diagnostic reasoning. N Engl J Med. 2006 Nov 23;355(21):2217-25. Review. PubMed PMID: 17124019
http://www.ncbi.nlm.nih.gov/pubmed/17124019
Croskerry P. The importance of cognitive errors in diagnosis and strategies to minimize them. Acad Med. 2003 Aug;78(8):775-80. Review. PubMed PMID: 12915363
http://www.ncbi.nlm.nih.gov/pubmed/12915363
The Case of the Unexpected Outcome by Drs. Justin Hensley & Teresa Chan. AliEM MEdIC Series case 1.09.
http://aliem.com/wp-content/uploads/Case-of-the-Unexpected-Outcome.pdf
Do
Diagnostic Error in Medicine International Conference. Annual CME meeting for the Society to Improve Diagnosis in Medicine. $ Fee required
http://www.improvediagnosis.org/?page=CMEInformation
In-Depth Review
Watch
♥How Young Doctors Think: Teaching Clinical Decision Making. Lucey CR. 59 minutes.
https://youtu.be/SOesiCMSukI
The Long Reach of Reasoning. Steven Pinker and Rebecca Newberger Goldstein. Ted Talks. 15 minutes.
https://www.ted.com/talks/steven_pinker_and_rebecca_newberger_goldstein_the_long_reach_of_reason#t-196356
Read
♥Learning Clinical Reasoning, 2nd Edition. Kassirer JP et al. 352 pages. $40.66
http://www.amazon.com/Learning-Clinical-Reasoning-Jerome-Kassirer/dp/078179515X/ref=sr_1_1?s=books&ie=UTF8&qid=1449773798&sr=1-1
Clinical Reasoning in the Health Professions, 3rd Edition. Higgs J et al. 520 pages. $65.67
http://www.amazon.com/Clinical-Reasoning-Health-Professions-3e/dp/0750688858/ref=sr_1_1?s=books&ie=UTF8&qid=1449773108&sr=1-1
Do
Clinical Problem Solving. University of California San Francisco. Coursera. Free 6 week course. Participants will learn how to move efficiently from patient signs and symptoms to a rational and prioritized set of diagnostic possibilities and will learn how to study and read to facilitate this process
https://www.coursera.org/course/clinprobsolv