Clinical reasoning by pharmacists: A scoping review

Area of Science:

• Pharmacy Practice
• Cognitive Science
• Health Professions Education

Background:

• Clinical reasoning is a core competency for pharmacists.
• Lack of conceptual clarity complicates teaching and assessment of clinical reasoning.
• This scoping review examines cognitive processes and conceptualizations of clinical reasoning in pharmacists.

Purpose of the Study:

• To identify, map, and examine evidence on cognitive processes used by pharmacists.
• To understand the conceptualization of clinical reasoning in pharmacy practice.
• To inform teaching and assessment strategies for clinical reasoning.

Main Methods:

• Scoping review of primary research studies in seven databases (searched March 2021).
• Included studies examined cognitive processes in pharmacists during clinical scenarios.
• Descriptive analysis of study characteristics, conceptualizations, operationalizations, and findings, adhering to PRISMA extension for Scoping Reviews.

Main Results:

• Seventeen studies were included, focusing on diagnosis formation (9) or medication appropriateness (4).
• Clinical reasoning is conceptualized as a context-dependent cognitive process integrating knowledge and experience.
• Pharmacists use analytical and intuitive reasoning approaches, with analytical reasoning predominant in medication review.

Conclusions:

• Research on pharmacist clinical reasoning is growing.
• Clinical reasoning should be taught as a distinct stage of clinical decision-making.
• Explicit teaching and reflection on transparent cognitive processes are recommended.