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Drawing Boundaries: The Difficulty in Defining Clinical Reasoning.

Meredith Young1, Aliki Thomas, Stuart Lubarsky

  • 1M. Young is assistant professor, Department of Medicine, and research scientist, Centre for Medical Education, Faculty of Medicine, McGill University, Montreal, Quebec, Canada. A. Thomas is assistant professor, School of Physical and Occupational Therapy, and research scientist, Centre for Medical Education, Faculty of Medicine, McGill University; and researcher, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, Quebec, Canada. S. Lubarsky is assistant professor, Department of Neurology, and core member, Centre for Medical Education, Faculty of Medicine, McGill University, Montreal, Quebec, Canada. T. Ballard is a plastic surgery resident, University of Michigan, Ann Arbor, Michigan. D. Gordon is associate professor, Division of Emergency Medicine, Department of Surgery, Duke University School of Medicine, Durham, North Carolina. L.D. Gruppen is professor, Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Michigan, United States. E. Holmboe is senior vice president for milestone evaluation and development, Accreditation Council for Graduate Medical Education, Chicago, Illinois, and adjunct professor of medicine, Yale University, New Haven, Connecticut, and Feinberg School of Medicine, Northwestern University, Chicago, Illinois. T. Ratcliffe is associate professor, Department of Medicine, University of Texas Health Science Center, San Antonio, Texas. J. Rencic is associate professor of medicine, Tufts University School of Medicine, and member, Division of General Internal Medicine, Tufts Medical Center, Boston, Massachusetts. L. Schuwirth is professor of medical education, Flinders University, and director, Flinders University Prideaux Centre for Research in Health Professions Education, Adelaide, South Australia, Australia; and professor of medical education, Maastricht University, Maastricht, the Netherlands; Chang Gung University, Taoyuan City, Taiwan; and Uniformed Services University of the Health Sciences, Bethesda, Maryland. S.J. Durning is professor of medicine and director of graduate programs in health professions education, Uniformed Services University of the Health Sciences, Bethesda, Maryland.

Academic Medicine : Journal of the Association of American Medical Colleges
|January 26, 2018
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Summary

Understanding clinical reasoning is key for health professionals. This study suggests differing "boundary conditions" explain varied conceptualizations and fragmented research in clinical reasoning, advocating for explicit definitions to improve communication and collaboration.

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Area of Science:

  • Health Professions Education
  • Cognitive Science
  • Medical Education Research

Background:

  • Clinical reasoning is fundamental to healthcare practice.
  • Existing research on clinical reasoning is fragmented and lacks a unified understanding.
  • Variability in definitions and conceptualizations hinders progress in the field.

Purpose of the Study:

  • To explore the fragmentation in clinical reasoning literature.
  • To identify potential reasons for the lack of a shared understanding of clinical reasoning.
  • To propose a framework for improving research communication and collaboration in clinical reasoning.

Main Methods:

  • A literature synthesis on clinical reasoning in health professions.
  • A 'pause-and-reflect' exercise where review team members defined clinical reasoning independently.
  • Analysis of conceptual variability within the review team.

Main Results:

  • Significant variability in personal definitions and conceptualizations of clinical reasoning was observed within the review team.
  • The concept of 'boundary conditions' from mathematics is hypothesized to explain differing conceptualizations.
  • Different boundary conditions likely underlie diverse theoretical frameworks, methodologies, and assessment approaches in clinical reasoning research.

Conclusions:

  • Explicitly acknowledging and describing boundary conditions can enhance research communication.
  • Clarifying conceptualizations of clinical reasoning supports better teaching and assessment strategies.
  • Recognizing differing boundary conditions may foster new collaborative research partnerships.