What physicians reason about during admission case review.

Area of Science:

• Medical Education
• Clinical Reasoning
• Cognitive Science in Medicine

Background:

• Physicians perform complex reasoning beyond diagnosis during patient reviews, but these tasks are not well-defined.
• Existing research on clinical reasoning tasks remains largely theoretical.

Purpose of the Study:

• To explore and identify the specific reasoning tasks physicians undertake during patient admission reviews.
• To understand the frequency, timing, and relationships of these tasks in clinical practice.

Main Methods:

• A constant comparative approach was used to analyze transcripts from 38 audio-recorded case reviews.
• Analysis focused on identifying, categorizing, and mapping reasoning tasks performed by trainees and senior physicians.
• A previous list of reasoning tasks was utilized, with new tasks identified during analysis.

Main Results:

• A mean of 17.9 distinct reasoning tasks were observed per review, with a total of 26 tasks examined.
• Three overarching tasks (prioritization, diagnosis refinement, management planning) were consistently observed across all case review stages.
• Twenty-two context-dependent supporting tasks were identified, serving to enhance overarching tasks; two new tasks (assessing illness severity, patient decision-making capacity) were discovered.

Conclusions:

• Physician reasoning during case reviews involves a dynamic interplay of overarching and supporting tasks, often addressed iteratively.
• Findings offer insights into the 'what' and 'when' of clinical reasoning, valuable for professional development, training, and patient care.
• The iterative nature of task execution may necessitate novel approaches to teaching and assessing clinical communication and reasoning skills.