Instrumento para el desarrollo del razonamiento clínico

Abstract

Development of an instrument to assess clinical reasoningBackground: Teaching clinical reasoning is a challenge in medical education. Aim: To design a clinical reasoning assessment instrument. Material and Methods: Structured interviews were carried out to six physicians with at least five years experience. The Grounded Theory method was used to determine the relevant categories of the clinical reasoning process and the modified Delphi expert judgment method to validate the categories, the definition of observable behaviors and the format of the instrument. Results: The relevant reasoning categories were the reason for consultation, medical history, physical examination, additional tests, diagnosis, therapeutic options and reasoning reassessment capacity. Expert judgment assessed at a level of "strongly agree" and "agree" the sufficiency, clarity and pertinence of all categories, related observable behaviors and instrument format. The internal Kappa consistency yielded an index of 0.92. Conclusions: The resulting instrument was constructed with the following axes derived from the main categories and subcategories: reason for consultation, history, physical examination, additional tests, diagnosis, therapeutic options and reassessment capacity.

Remote simulation: A qualitative study on clinical reasoning and cognitive errors from the students' perspective

“…Esto se debe a que permite el intercambio de información y conocimiento con el equipo, lo cual es crucial para el razonamiento clínico. (24,50,51,52) En este estudio, los participantes se refirieron a la relevancia del trabajo diciendo que permite analizar más perspectivas y puntos de vista, reconociendo que "tenemos la tendencia a encerrarnos en nuestras creencias y conocimientos, dejando pasar diferentes perspectivas que muchas veces pueden considerar mejores opciones". Esta expresión reconoce que el trabajo en equipo es una buena herramienta para evitar algún tipo de error cognitivo como el anclaje o el cierre prematuro, (16,53,54,55) por ejemplo.…”

Changes in clinical reasoning and cognitive error after a intensive online course: A Qualitative study in medical students

“…The concept of clinical reasoning described by the participants, especially after the intervention, is very similar to the concept found in literature, probably because of clinical reasoning is a mainstay in medical training, a necessary cognitive process to analyze and solve a patient's clinical problem, 2 in an appropriate way, in the patient's benefit. 1 Before the course participants express ideas that seem to reflect an understanding of clinical reasoning as a linear process and after the course they use expressions that reveal an understanding of clinical reasoning as a cyclical process, with control mechanisms that articulate and constitute a kind of continuous improvement process. 4 In regards to the purpose of clinical reasoning, participants agreed that it is carried out to make a diagnosis and determine or guide towards an appropriate treatment, and as a final objective "solve a case or clinical problem".…”

“…This is consistent with the current literature, since it has been described that the most important part of the teaching of clinical reasoning emphasizes the mental process by which thinking is organized, rather than on the result alone. 1,11 Regarding the context, in both instances they refer to it as a case or clinical scenario, when facing a patient. The way in which contextual factors impact the clinical reasoning performance of medical students has been studied.…”