文章基本信息

标题：Context and clinical reasoning
本地全文：下载
作者：Elexis McBee ; Temple Ratcliffe ; Lambert Schuwirth 等
期刊名称：Perspectives on Medical Education
印刷版ISSN：2212-2761
电子版ISSN：2212-277X
出版年度：2018
卷号：7
期号：4
页码：256-263
DOI：10.1007/s40037-018-0417-x
出版社：Springer Verlag
摘要：IntroductionStudies have shown that a physician’s clinical reasoning performance can be influenced by contextual factors. We explored how the clinical reasoning performance of medical students was impacted by contextual factors in order to expand upon previous findings in resident and board certified physicians. Using situated cognition as the theoretical framework, our aim was to evaluate the verbalized clinical reasoning processes of medical students in order to describe what impact the presence of contextual factors has on their reasoning performance. MethodsSeventeen medical student participants viewed three video recordings of clinical encounters portraying straightforward diagnostic cases in internal medicine with explicit contextual factors inserted. Participants completed a computerized post-encounter form as well as a think-aloud protocol. Three authors analyzed verbatim transcripts from the think-aloud protocols using a constant comparative approach. After iterative coding, utterances were analyzed and grouped into categories and themes. ResultsSix categories and ten associated themes emerged, which demonstrated overlap with findings from previous studies in resident and attending physicians. Four overlapping categories included emotional disturbances, behavioural inferences about the patient, doctor-patient relationship, and difficulty with closure. Two new categories emerged to include anchoring and misinterpretation of data. DiscussionThe presence of contextual factors appeared to impact clinical reasoning performance in medical students. The data suggest that a contextual factor can be innate to the clinical scenario, consistent with situated cognition theory. These findings build upon our understanding of clinical reasoning performance from both a theoretical and practical perspective.
关键词：Clinical reasoning ; Medical education ; Situated cognition ; Qualitative methods