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How clinicians think : changing gear to arrive at the right diagnosis. An exploratory study on the transition from the routine to the effortful mode of clinical reasoning.

Smeenk, Carmen (2016) How clinicians think : changing gear to arrive at the right diagnosis. An exploratory study on the transition from the routine to the effortful mode of clinical reasoning.

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Abstract:In order to arrive at the right diagnosis and thereby prevent diagnostic error and patient harm, changing gear by making the transition from a more routine to a more effortful mode of clinical reasoning, when needed, is crucial. Although many studies have emphasized the importance of this so-called slowing down, only a few have tried to explore it in action. Moreover, as it concerns a crucial component of clinical reasoning every student should be competent at it, however no educational material focuses on this phenomenon yet. To understand how slowing down should be taught one must first gain understanding on how the transition to the more effortful mode of clinical reasoning is made in practice. The current research therefore explored slowing down in clinical reasoning among clinicians who have patient contact in the policlinic. This was done by interviewing and observing radiologists that are conducting their daily tasks. During their work, five radiologists were interviewed before a consultation with a patient, observed during the consultation and again interviewed afterwards. These instruments made it possible to link thoughts and actions as actions could be observed and by the researcher, while the participants could verbalize what they did, why they did it and what they thought at that particular moment. During fourteen of the forty-one observed consultations the transition to the more effortful mode of clinical reasoning was made. Due to a missing post interview, one of these cases was excluded, resulting in a total of thirteen slowing down cases analyzed. The analysis of these cases resulted in the identification of four distinct forms of making the transition to the effortful mode: shifting, checking, searching and focusing. Furthermore several triggers that initiate these forms of slowing down were found: a patient statement; the ultrasound screen that shows an unknown, unlikely of unexpected image; and the ultrasound that does not show anything as it shows no abnormalities or a blurred image. In addition to these findings, the results show that making the transition from the more routine to the more effortful mode of clinical reasoning is something that can be observed. Moreover, there can be concluded that it concerns a phenomenon that can be measured. With these insights a step towards educating student to slow down can be made.
Item Type:Essay (Master)
Faculty:BMS: Behavioural, Management and Social Sciences
Subject:81 education, teaching
Programme:Educational Science and Technology MSc (60023)
Link to this item:http://purl.utwente.nl/essays/69760
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