Abstract
This article was migrated. The article was marked as recommended. Background Research about clinical reasoning has tended to focus on the individual, assessing their ability to perform clinical reasoning tasks. However, recent studies have noted that clinical reasoning varies with the clinical context. Objectives The purpose of this narrative review is to examine how the context can affect physicians clinical reasoning skills. Methods A narrative literature review was conducted by searching PubMed, PsycINFO and Embase via Ovid using the search terms clinical OR critical AND thinking OR judgement OR reasoning. Of 22,296 results found, 25 studies were found to be relevant to our review. Results Most studies focused on diagnostic skills. Contexts affecting clinical reasoning fell into three broad categories: patient, physician and environmental (the physical and social setting) factors. Patient contexts researched included factors both personal to the patient and their physical disease manifestations. Physician contexts included experience, age, exposure to similar diagnoses, incorrect diagnostic suggestion, emotions, and the use of reflection and checklists. Environmental contexts included time pressure, unfamiliarity with surroundings, dealing with uncertainty and high-stakes outcomes. The effect of applying more than one contextual factor increasing cognitive load, was explored. Conclusion This original review suggests that the context can affect a physician's clinical reasoning abilities. This review identifies areas for continued research, including which contexts have a negative or positive impact, and the effect of multiple contexts (cognitive loading) on clinical reasoning. Further empirical research is needed to investigate these areas in more depth and to establish how far these benefits have an impact in practice.
Highlights
Clinical reasoning (CR) has been defined as a way of thinking and decision making in professional practice (Higgs and Jones, 2000), requiring physicians to sort through a cluster of features and accurately assign a diagnosis and develop a treatment strategy (Eva K, 2005)
Contexts affecting clinical reasoning fell into three broad categories: patient, physician and environmental factors
The effect of applying more than one contextual factor increasing cognitive load, was explored. This original review suggests that the context can affect a physician’s clinical reasoning abilities
Summary
Clinical reasoning (CR) has been defined as a way of thinking and decision making in professional practice (Higgs and Jones, 2000), requiring physicians to sort through a cluster of features and accurately assign a diagnosis and develop a treatment strategy (Eva K, 2005). The context in medical education has previously been defined as a complex system evolving over time, with the outcome being driven by interactions and feedback among patient, physician, setting, and their interactions (Durning et al, 2010). ‘Context specificity’, the phenomenon of a physician’s performance varying on a case by case or situation to situation basis, has been well described (Eva, 2003). Recent studies have noted that clinical reasoning varies with the clinical context
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
