<p>Five decades of research and theorization on clinical reasoning: a critical review</p>

Abstract

Clinical reasoning is a complex cognitive process that is essential to evaluate and manage a patient’s medical problem. The aim of this paper was to provide a critical review of the research literature on clinical reasoning theories and models. To conduct our study, we applied the process of conducting a literature review in four stages in accordance with the approach of Carnwell and Daly. First, we defined the scope of the review as being limited to clinical reasoning theories and models in medical education. In the second stage, we conducted a search based on related words in PubMed, Google Scholar, PsycINFO, ERIC, ScienceDirect and Web of Science databases. In the third stage, we classified the results of the review into three categories, and in the fourth stage, we concluded and informed further studies. Based on the inclusion and exclusion criteria, 31 articles were eligible to be reviewed. Three theories and two models were recognized and classified into three categories. Several theories and models have been proposed in relation to clinical reasoning, but it seems that these theories and models could only explain part of this complex process and not the whole process. Therefore, to fulfill this gap, it may be helpful to build a Meta-model or Meta-theory, which unified all the models, and theories of clinical reasoning.

Clinical Reasoning in Forensic Psychiatry: Concepts, Processes, and Pitfalls

“…As reasoning is a domain of cognitive function, clinical reasoning literature has increasingly relied on concepts from cognitive sciences ( 14 ). Three of the most prominent theories of clinical reasoning will be discussed here: the hypothetico-deductive model, illness script theory, and dual process theory ( 15 ). In these cognition-oriented theories, the human emotion is considered as a factor that may influence the cognitive processes involved in reasoning ( 16 , 17 ).…”

“…In its original formulation, the hypothetico-deductive model does not differentiate between the clinical reasoning process of a novice and an expert. It was later proposed that the difference lies on the quality of the hypotheses: experts generate stronger hypotheses so that the testing phase becomes more efficient ( 15 , 21 , 22 ).…”

“…The three main components of an illness script are the Enabling Conditions , factors that determine the probability of a certain disease; the Fault , pathophysiology of the disease; and the Consequences , the manifestation of the disease ( 23 ). Illness scripts can be described as list-like structures containing a clinician's expected findings in a disease ( 15 ). These scripts are generated by repeated direct experience and stored in long-term memory ( 23 ).…”

“…Dual process theory (DPT) was first developed in the field of cognitive sciences. This theory was then later adapted to medicine as it may help elucidate the different processes clinicians use to reach a decision ( 15 , 27 ). According to the theory, any cognitive task can activate two forms of processing ( 28 ).…”

Reasoning like a doctor or like a nurse? An integrative review protocol

“…Clinical reasoning, which is a highly complex system with multiple interdependent mental activities, 3 can be viewed from three perspectives: the process of reasoning, the knowledge structures, and the extent of analytical or intuitive cognitive modes. 4 Clinical reasoning is considered a multifaceted concept, coupled with the potential for misunderstanding. 5 In the clinical reasoning literature, concepts or terms like clinical judgement,…”