Clinical Reasoning Skills


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Levels of Knowledge and Application of Clinical Reasoning

The level of knowledge of the learner determines capabilities for application of clinical reasoning skills. The more advanced the learner, the more advanced the reasoning process. The levels are:

  • Reduced: has little knowledge; uses intuition and guessing strategy for problem solving. Novice learners often rely on intuition, with rapid responses to situations by pattern recognition or initial impression. Intuition can be influenced by emotional state. Nevertheless, intuition is useful for generating an initial list of hypotheses.

  • Dispersed: has limited and superficial, but not deep, knowledge. Uses hypothetical deductive reasoning strategy for problem solving. Hypotheses are formulated by reasoning backward from the data. Intermediate learners.

  • Elaborated causal: has more extensive deep knowledge including probabilistic and cause-effect knowledge. Uses hypothetical deductive reasoning for problem solving. Hypotheses are formulated by reasoning backward from the data. They are more likely to make a correct diagnosis compared to learners with dispersed (limited) knowledge.

  • Hierarchical: has knowledge of expert schemes with organized differential diagnoses based upon common attributes in defined categories. Reasoning is applied in a forward fashion using the data in an expert-derived scheme or algorithm. There is 5-fold increase in arriving at the correct diagnosis over use of hypothetico-deductive reasoning.

  • Scripted: applies pattern recognition from long-term memory of numerous past examples. This is mostly an unconscious, non-analytic process used by experts. They then perform further investigations that are primarily confirmatory. There is a high degree of accuracy of getting the correct diagnosis, a 10-fold increase over use of hypothetico-deductive reasoning. However, the pure use of pattern recognition by novices and intermediate learners is not recommended.

Reference:

Harasym PH, Tsai TC, Hemmati P. Current trends in developing medical students' critical thinking abilities. Kaohsiung J Med Sci. 2008;24(7):341-55.


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