Clinical Reasoning and Problem Solving

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Clinical ReasoningandProblem Solving
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The Clinical Teacher
Diagnose the Learner
Level Knowledge Experience Reasoning
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Organization of knowledge

• Classroom Curriculum organ systems, pathology
• Clinical knowledge Based on
• Clinical features---knowledge---experience

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Thinking.Classroom or clinical
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Clinical Diagnostic Reasoning
Patient story
Knowledge
Data
Problem representation
Context
Hypothesis
Illness script
Diagnosis
Experience
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Problem representationBased on patient story,
PE, dataTranslation of patient-specific into
abstract terms
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Clinical Diagnostic Reasoning
Patient story
Knowledge
Data
Problem representation
Context
Hypothesis
Illness script
Diagnosis
Experience
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ReasoningDescribed with semantic
qualifiersPaired, opposing descriptors
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Illness scriptRecalled, structured
knowledgeTriggered by problem representationClin
ically relevant informationOutcomes,
solutionsPurposeful data gathering
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Clinical Diagnostic Reasoning
Patient story
Knowledge
Data
Problem representation
Context
Hypothesis
Illness script
Diagnosis
Experience
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Promote diagnostic reasoning

• Experience
• Articulate problem representation
• Prioritize and justify diagnostic possibilities
• Develop illness scripts/disease concepts

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What can we do as teachers?

• Promote reasoning aloud
• Ask
• What are you unsure of?
• What cant you explain?
• Use abstract qualifiers
• Defining features
• Discriminating features
• Compare and contrast
• Shorten and focus the differential list

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Instruction-Related activities in Rounds
Listening
Planning
Reflecting
Thinking interactively
Teaching
Diagnose patient
Diagnose learner