Clinical Reasoning and Problem Solving The Clinical Teacher

Clinical Reasoning and Problem Solving

The Clinical Teacher Diagnose the Patient Diagnose the Learner Level Knowledge Experience Reasoning

Organization of knowledge Classroom: Curriculum organ systems, pathology Clinical knowledge: Based on Clinical features---knowledge---experience

Thinking…. Classroom or clinical

Clinical Diagnostic Reasoning Knowledge Patient story Data Problem representation Context Hypothesis Illness script Diagnosis Experience

Problem representation… Based on patient story, PE, data Translation of patient-specific into abstract terms

Clinical Diagnostic Reasoning Knowledge Patient story Data Problem representation Context Hypothesis Illness script Diagnosis Experience

Reasoning… Described with semantic qualifiers Paired, opposing descriptors

Illness script… Recalled, structured knowledge Triggered by problem representation Clinically relevant information Outcomes, solutions Purposeful data gathering

Clinical Diagnostic Reasoning Knowledge Patient story Data Problem representation Context Hypothesis Illness script Diagnosis Experience

Promote diagnostic reasoning: 1. Experience 2. Articulate problem representation 3. Prioritize and justify diagnostic possibilities 4. Develop illness scripts/disease concepts

What can we do as teachers? Promote reasoning aloud Ask – What are you unsure of? – What can’t you explain? Use abstract qualifiers – – Defining features Discriminating features Compare and contrast Shorten and focus the differential list

Instruction-Related activities in Rounds Thinking interactively Diagnose learner Diagnose patient Planning Teaching Listening Reflecting