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Sequence matters: patterns in task-based clinical reasoning.

Michael Soh1, Abigail Konopasky1, Steven J Durning1

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Summary
This summary is machine-generated.

Clinical reasoning tasks typically follow a sequence, but complex cases can disrupt this pattern. Experienced physicians may adapt their reasoning process when faced with challenging patient encounters.

Keywords:
situated cognitionsituativitysocial cognitive theorytask-based clinical reasoning

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Area of Science:

  • Cognitive Science
  • Medical Education
  • Clinical Reasoning

Background:

  • Clinical reasoning involves various cognitive tasks, including framing, diagnosis, management, and reflection.
  • The temporal use and evolution of these tasks in complex patient encounters remain largely unexplored.

Purpose of the Study:

  • To investigate the sequence of clinical reasoning tasks.
  • To determine how contextual factors influence these task sequences.
  • To explore if experienced physicians' reasoning changes with complex cases.

Main Methods:

  • Analysis of 60 think-aloud transcripts from 30 physicians across two cases (one with a contextual factor, one without).
  • Coding of 26 distinct clinical reasoning tasks and their temporal emergence.
  • Aggregation, categorization, and visualization of task frequencies to analyze sequences.

Main Results:

  • Clinical reasoning tasks generally follow a predictable sequence.
  • Contextual factors were found to distort this typical task sequence.
  • The presence of contextual factors led experienced physicians to adopt reasoning patterns similar to less experienced physicians.

Conclusions:

  • Clinical reasoning is context-specific, with complex factors altering established task sequences.
  • Findings enhance understanding of clinical reasoning processes in challenging situations.
  • The study offers insights for improving clinical reasoning teaching and assessment.