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Integrating competencies: exploring complex problem solving through case formulation in developmental pediatrics.

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Experienced clinicians solve complex patient problems by interpreting patient factors, collaborating with parents and teams, and refining their case formulations over time. This iterative process is key to developing clinical expertise.

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Area of Science:

  • Medical Education
  • Clinical Psychology
  • Healthcare Management

Background:

  • Case formulation is a critical clinical skill for explaining patient presentations.
  • Understanding how clinicians solve complex problems is essential for medical training.

Purpose of the Study:

  • To explore how experienced clinicians formulate cases.
  • To investigate the broader processes of complex problem-solving in daily clinical work.

Main Methods:

  • Constructivist grounded theory study.
  • Semistructured interviews with 12 physicians.
  • Constant comparative analysis of interview data.

Main Results:

  • Three themes emerged: interpreting patient factors within medical knowledge, co-constructing formulations with parents/teams, and refining formulations longitudinally.
  • These themes characterize experienced clinicians' complex problem-solving during case formulation.

Conclusions:

  • Interpretive, strategic, and longitudinal processes are central to experienced clinicians' complex problem-solving.
  • Findings illuminate how clinicians integrate competencies and have implications for expertise development and pedagogical practices.