ABC of Clinical Reasoning E-Book

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Serie: ABC Series
• Sprache: Englisch

Seitenzahl: 190

Veröffentlichungsjahr: 2016

Beschreibung

Being a good clinician is not just about knowledge – how doctors and other healthcare professionals think, reason and make decisions is arguably their most critical skill. While medical schools and postgraduate training programmes teach and assess the knowledge and skills required to practice as a doctor, few offer comprehensive training in clinical reasoning or decision making. This is important because studies suggest that diagnostic error is common and results in significant harm to patients – and errors in reasoning account for the majority of diagnostic errors.

The ABC of Clinical Reasoning covers core elements of the thinking and decision making associated with clinical practice – from what clinical reasoning is, what it involves and how to teach it. Informed by the latest advances in cognitive psychology, education and studies of expertise, the ABC covers:

• Evidence-based history and examination
• Use and interpretation of diagnostic tests
• How doctors think – models of clinical reasoning
• Cognitive and affective biases
• Metacognition and cognitive de-biasing strategies
• Patient-centred evidence based medicine
• Teaching clinical reasoning

From an international team of authors, the ABC of Clinical Reasoning is essential reading for all students, medical professionals and other clinicians involved in diagnosis, in order to improve their decision-making skills and provide better patient care.

Leseprobe

Table of Contents

Cover

Title Page

Contributors

Preface

CHAPTER 1: Clinical Reasoning

Introduction

What is clinical reasoning?

Why is clinical reasoning important?

History and examination

Probability and diagnostic tests

Clinicians are human too

Clinical reasoning matters to patients

Summary

Further reading/resources

CHAPTER 2: Evidence-Based History and Examination

Introduction

Evidence-based history

Natural history and context

Evidence-based physical examination

Using likelihood ratios

The limitations of evidence-based history and examination

Example: diagnosing stable coronary artery disease

Combining clinical findings

Conclusions

Further reading/resources

CHAPTER 3: Using and Interpreting Diagnostic Tests

Introduction

Normal values

Factors other than disease that influence test results

Operating characteristics

Sensitivity and specificity

Prevalence of disease in the population

Thresholds

Summary

Further reading/resources

CHAPTER 4: Models of Clinical Reasoning

Introduction

Deductive reasoning

Hypothetico-deductive reasoning

Inductive reasoning

Abductive reasoning

Rule-based/categorical/deterministic reasoning

Probabilistic reasoning

Causal reasoning

Making a diagnosis – hypothesis generation and modification

Type 1 and type 2 thinking – dual process theory

Errors in the diagnostic process

The reasoning of experts versus novices

Summary

Further reading/resources

CHAPTER 5: Cognitive Biases

Introduction

Case history

Common cognitive biases

Is bias only a type 1 thinking problem?

Cognitive biases and expert intuition

Summary

Further reading/resources

CHAPTER 6: Human Factors

Introduction

Error in healthcare

The limitations of human performance

Communication within teams

Embedding human factors in healthcare

Summary

Further reading/resources

CHAPTER 7: Metacognition and Cognitive Debiasing

Introduction

‘Brutish automatism’

Cognitive debiasing

Overall challenges of debiasing

Summary

Further reading/resources

CHAPTER 8: Using Guidelines, Scores and Decision Aids

Introduction

Clinical guidelines

Scores and decision aids

The pitfalls of using guidelines, scores and decision aids

Applying clinical guidelines in practice – helping patients to share decision-making

Summary

Further reading/resources

CHAPTER 9: Teaching Clinical Reasoning

Introduction

A spiral curriculum

Educational theories relevant to clinical reasoning

Teaching techniques

Reflection in clinical reasoning