ABC of clinical reasoning

66 Pages·2017·3.809 MB·English

by  Cooper, Nicola;Frain, John Patrick James

Clinical Reasoning

Clinical Reasoning
EDITED BY
Nicola Cooper
Consultant Physician and Honorary Clinical Associate Professor
Derby Teaching Hospitals NHS Foundation Trust and
Division of Medical Sciences and Graduate Entry Medicine,
University of Nottingham, UK
John Frain
General Practitioner and Director of Clinical Skills
Division of Medical Sciences and Graduate Entry Medicine,
University of Nottingham, UK
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1 2017
Contents
Contributors, vi
Preface, vii
1 Clinical Reasoning: An Overview, 1
Nicola Cooper and John Frain
2 Evidence‐Based History and Examination, 6
Steven McGee and John Frain
3 Using and Interpreting Diagnostic Tests, 12
Nicola Cooper
4 Models of Clinical Reasoning, 17
Martin Hughes and Graham Nimmo
5 Cognitive Biases, 22
Nicola Cooper
6 Human Factors, 27
Nicola Cooper
7 Metacognition and Cognitive Debiasing, 33
Pat Croskerry
8 Using Guidelines, Scores and Decision Aids, 39
Maggie Bartlett and Simon Gay
9 Teaching Clinical Reasoning, 44
Nicola Cooper, Ana L. Da Silva and Sian Powell
Recommended Books, Articles and Websites, 51
Index, 53
v
Contributors
Maggie Bartlett Martin Hughes
MBChB FRCGP MA (medical education) SFHEA MBChB BSc MRCP FRCA FFICM
Senior Lecturer in Medical Education, Keele School of Medicine, UK Consultant in Anaesthesia and Intensive Care Medicine, Royal Infirmary,
Glasgow, UK
Nicola Cooper
Steven McGee
MBChB FAcadMEd FRCPE FRACP
Consultant Physician and Honorary Clinical Associate Professor, MD
Derby Teaching Hospitals NHS Foundation Trust and Division Professor of Medicine, University of Washington
of Medical Sciences and Graduate Entry Medicine, University General Medical Service
of Nottingham, UK Department of Veterans Affairs Medical Center, Seattle, WA, USA
Pat Croskerry Graham Nimmo
MD PhD FRCPE MBChB BSc MD EdD FRCP(Edin) FFARCSI FFICM
Director, Critical Thinking Program, Division of Medical Education, Consultant in Intensive Care Medicine and Clinical Education
Dalhousie University, Canada Western General Hospital, Edinburgh, UK
John Frain Sian Powell
MBChB MSC FRCGP DCH DGM DRCOG PGDipCard MBChB MRCP MRCGP MA (Clin Ed)
General Practitioner; Director of Clinical Skills, Division of GP and Course Lead for Year 6 General Practice Student Assistantship,
Medical Sciences and Graduate Entry Medicine, University of Department of Primary Care and Public Health, Imperial College School of
Nottingham, UK Medicine, Charing Cross Hospital, London, UK
Simon Gay Ana L. Da Silva
MBBS FRCGP MSc MA (medical education) SFHEA PhD AFHEA
Senior Lecturer in Medical Education, Keele School Lecturer in Medical Education, Swansea University Medical School,
of Medicine, UK Swansea, UK
vi
Preface
Excellence in medicine is not just about good knowledge, skills Clinical reasoning is not confined to doctors – we have written
and behaviours. How doctors think, reason and make decisions is this book with advanced nurse practitioners and other clinicians
arguably their most critical skill. While medical schools and post- in mind, and try to use the word clinician’ rather than ‘doctor’
graduate training programmes teach and assess the knowledge whenever we can.
and skills required to practise as a doctor, few offer comprehen- Clinical reasoning is relevant to every single specialty from gen-
sive training in clinical reasoning or decision‐making. This is eral practice to surgery to the intensive care unit. While some aspects
important because studies suggest that diagnostic error is of clinical reasoning are not new, advances in cognitive psychology
common and results in significant harm to patients. Diagnostic and a better understanding of patient safety mean there are elements
error typically has multiple causes, but two‐thirds of the root of clinical reasoning that many clinicians may be unfamiliar with.
causes involve human cognitive error – most commonly, when We can only provide an introduction to the different elements of
the available data are not synthesised correctly. While some of clinical reasoning in this book, so each chapter has a list of further
this is due to inadequate knowledge, a significant amount is due reading and resources. We have also provided a list of recommended
to inadequate reasoning. books, articles and websites at the end of the book so readers can
Clinical reasoning has several elements, which are covered in continue to explore clinical reasoning in more depth for themselves.
this book, from evidence‐based clinical skills to the use and inter- We really enjoyed writing and editing this book, we hope you
pretation of diagnostic tests to cognitive psychology, thinking enjoy reading and using it!
about thinking and human factors. This book is designed to be an
introduction for individuals and also a resource for a curriculum Nicola Cooper and John Frain
in clinical reasoning. January 2016
vii