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Management Reasoning: Empirical Determination of Key Features and a Conceptual Model
David A Cook1, Christopher R Stephenson2, Larry D Gruppen3
1D.A. Cook is professor of medicine and professor of medical education, director of education science, Office of Applied Scholarship and Education Science, and consultant, Division of General Internal Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota; ORCID: https://orcid.org/0000-0003-2383-4633 .
Summary
This study identifies key features of clinical management reasoning, highlighting the crucial role of management scripts and shared decision-making between clinicians and patients. The findings reveal management reasoning is a personalized, collaborative process.
Area of Science:
- Clinical reasoning
- Medical education
- Health professions education
Background:
- Clinical management reasoning is critical but understudied in practice and education.
- Empirical identification of its core components and process is needed.
Purpose of the Study:
- To empirically identify key features of clinical management reasoning.
- To construct a model describing the management reasoning process.
Main Methods:
- Investigators analyzed video clips of simulated physician-patient encounters.
- A constant comparative approach was used to distill observations into key features and insights.
- Iterative discussions refined findings into a management reasoning model.
Main Results:
- Identified 12 features: solution contrast, prioritization, communication, monitoring, dynamic interplay, knowledge types, scripts, clinician roles, relationships, prognostication, and organization.
- Management scripts were prominent.
- A 4-step model emerged: script instantiation, option identification/patient teaching, shared decision-making, and ongoing adjustment.
- Reasoning is personalized and occurs between individuals.
Conclusions:
- Management scripts, patient teaching, shared decision-making, monitoring, and personalization are key.
- Management reasoning is a negotiated, interpersonal process, not solely internal to the clinician.
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