Mapping clinical reasoning literature across the health professions: a scoping review

Abstract

Background: Clinical reasoning is at the core of health professionals' practice. A mapping of what constitutes clinical reasoning could support the teaching, development, and assessment of clinical reasoning across the health professions. Methods: We conducted a scoping study to map the literature on clinical reasoning across health professions literature in the context of a larger Best Evidence Medical Education (BEME) review on clinical reasoning assessment. Seven databases were searched using subheadings and terms relating to clinical reasoning, assessment, and Health Professions. Data analysis focused on a comprehensive analysis of bibliometric characteristics and the use of varied terminology to refer to clinical reasoning. Results: Literature identified: 625 papers spanning 47 years (1968-2014), in 155 journals, from 544 first authors, across eighteen Health Professions. Thirty-seven percent of papers used the term clinical reasoning; and 110 other terms referring to the concept of clinical reasoning were identified. Consensus on the categorization of terms was reached for 65 terms across six different categories: reasoning skills, reasoning performance, reasoning process, outcome of reasoning, context of reasoning, and purpose/goal of reasoning. Categories of terminology used differed across Health Professions and publication types. Discussion: Many diverse terms were present and were used differently across literature contexts. These terms likely reflect different operationalisations, or conceptualizations, of clinical reasoning as well as the complex, multi-dimensional nature of this concept. We advise authors to make the intended meaning of 'clinical reasoning' and associated terms in their work explicit in order to facilitate teaching, assessment, and research communication.

Relationship between metacognitive awareness and motivation to learn in medical students

“…Thus, more efficient study plans, responsibilities and deep learning should be developed [ 9 ]. Recent studies have also shown that metacognitive practices result in better patient care [ 12 ], clinical reasoning [ 13 ], clinical decision making [ 14 ], and a continuous process of lifelong learning, which is essential in medical practice [ 11 , 15 – 17 ].…”

Scoping reviews in medical education: A scoping review

“…We included 101 studies (See Appendix for a diagram of the inclusion process) 18‐118 . On average 10.1 scoping reviews (SD = 13.1, median = 4, range 0‐42) were published annually (See Appendix ) with the most published in 2019 (n = 42; 41.6%).…”

“…The first scoping review in our sample was published in 2011. Scoping reviews were featured in 13 of the 14 journals with Academic Medicine (n = 28, 27.7%), 18,24,33,35‐38,44,48,49,52,55,58,61,62,68,72,73,76,90,92,94,97,100,104,112,115,116 Medical Education (n = 18, 17.8%) 20,22,27,32,40,46,56,60,63,65‐67,77,103,108‐111 and BMC Medical Education (n = 16, 15.8%) 19,26,29,39,45,50,51,58,69,70,84,85,87,96,105,113 publishing the most. Clinical Teacher did not publish any scoping reviews during this time period.…”

“…Thirty‐eight scoping reviews (37.6%) 19,26,28,34,38,40,41,44,49,51,53,58,60,62,65,66,70,72‐75,87,88,90,92,96,97,100‐102,105,106,109,110,112,117 reported funding that supported the work with nearly half (39.5%) 41,44,49,70,72,73,75,87,88,90,92,100,101,105,115 of those funded receiving public funds. All reviews synthesised journal articles, with 28.7% (n = 29) also including book chapters, grey literature, dissertations, websites, posters and conference proceedings 19,23,30,31,34,38‐40,42,51,56,57,59,61,63,64,71,75,76,88,92,93,95,99,104,106,108,114,117 . Of those that focused only on journal articles, multiple reviews limited inclusion to original research studies, thereby excluding commentaries, letters, editorials and review articles.…”

What is “shared” in shared decision‐making? Philosophical perspectives, epistemic justice, and implications for health professions education

“…As an occupational therapist and rehabilitation scientist (A.T., first author), my research focus on how clinical experience and expertise impact clinicians' use of research evidence has led me to explore how clinical decision‐making occurs in complex systems of care, and to identify the factors that support or inhibit clinicians' use of scientific evidence in practice . Two themes continue to arise in conversations with health care professionals that relate to their experience of both testimonial and hermeneutic epistemic injustice: (a) feelings of powerlessness and (b) a tension between meeting performance indicators and working with patients as unique individuals, with different aspirations, timelines, and priorities.…”