Objectives
The current
study sought to explain how different professional experiences led Singaporean
psychiatrists to alter their clinical reasoning processes as their careers
evolved from psychiatry residents to senior consultant psychiatrists.
Methods
The current
qualitative study interviewed 26 clinicians at various stages of their
psychiatric career, spanning residents to senior psychiatrists. The authors used a constructivist grounded
theory approach to structure the collection and analysis of data. Analyses
produced a dense theoretical explanation rooted in the experiences of
participants.
Results
Several
differences emerged between the way psychiatry residents and senior psychiatrists
explained their reasoning process and the experiences on which they based their
preference. Residents preferred using deductive logic-driven frameworks that
were diagnosis-centric, because of the pressures they experienced during their
training and assessments. Senior psychiatrists emphasized a more holistic and
problem-centric approach. Participants attributed the changes that occurred
over time to practical experiences, such as their greater clinical
responsibility and independence, and individual experiences, such as growing
sensitivity to the clinical reasoning process or their growing propensity for
professional reflectiveness. These changes manifest as an increase in
repertoire and flexibility in deployment of different clinical reasoning strategies.
Conclusions
It is
important for trainees to be aware of the deductive and inductive modes of
clinical reasoning during supervision and to be comfortable with shifting
clinical focus from diagnoses to specific individual problems. Training programs
should provide and plan adequate longitudinal clinical exposure to develop
clinical reasoning abilities in a way that allows consequences of decisions to
be explored. Continued faculty development to ease the diversification of
clinical reasoning skills should be encouraged, as should reflectivity in the
learners during clinical supervision.