How do gut feelings feature in tutorial dialogues on diagnostic reasoning in GP traineeship?

C F Stolper,M W J Van De Wiel,M A Van Bokhoven,T Van Der Weijden,G J Dinant,R H M Hendriks,P Van Royen

doi:10.1007/s10459-014-9543-3

C F Stolper, M W J Van De Wiel + Show 5 more

Open Access

https://doi.org/10.1007/s10459-014-9543-3

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Abstract

Diagnostic reasoning is considered to be based on the interaction between analytical and non-analytical cognitive processes. Gut feelings, a specific form of non-analytical reasoning, play a substantial role in diagnostic reasoning by general practitioners (GPs) and may activate analytical reasoning. In GP traineeships in the Netherlands, trainees mostly see patients alone but regularly consult with their supervisors to discuss patients and problems, receive feedback, and improve their competencies. In the present study, we examined the discussions of supervisors and their trainees about diagnostic reasoning in these so-called tutorial dialogues and how gut feelings feature in these discussions. 17 tutorial dialogues focussing on diagnostic reasoning were video-recorded and transcribed and the protocols were analysed using a detailed bottom-up and iterative content analysis and coding procedure. The dialogues were segmented into quotes. Each quote received a content code and a participant code. The number of words per code was used as a unit of analysis to quantitatively compare the contributions to the dialogues made by supervisors and trainees, and the attention given to different topics. The dialogues were usually analytical reflections on a trainee’s diagnostic reasoning. A hypothetico-deductive strategy was often used, by listing differential diagnoses and discussing what information guided the reasoning process and might confirm or exclude provisional hypotheses. Gut feelings were discussed in seven dialogues. They were used as a tool in diagnostic reasoning, inducing analytical reflection, sometimes on the entire diagnostic reasoning process. The emphasis in these tutorial dialogues was on analytical components of diagnostic reasoning. Discussing gut feelings in tutorial dialogues seems to be a good educational method to familiarize trainees with non-analytical reasoning. Supervisors need specialised knowledge about these aspects of diagnostic reasoning and how to deal with them in medical education.

Highlights

Diagnostic reasoning is part of the core business of general practitioners (GPs), and teaching diagnostic reasoning has to be a part of GP traineeships
We examined the discussions of supervisors and their trainees about diagnostic reasoning in these so-called tutorial dialogues and how gut feelings feature in these
The purpose of our study was to explore the discussions about diagnostic reasoning in tutorial dialogues of supervising GPs and their trainees and how gut feelings featured in these dialogues

Summary

Introduction

Diagnostic reasoning is part of the core business of general practitioners (GPs), and teaching diagnostic reasoning has to be a part of GP traineeships. Many diagnoses are automatically recognized by experienced GPs (Norman et al 2006) They immediately interpret a patient’s problem in diagnostic terms and do not engage in elaborate analytical thought processes. The latter are used in more complex patient problems for which the GP has no diagnosis readily available. Sometimes a GP becomes aware of a sense of alarm, i.e. the feeling that there may be something wrong with the patient, without knowing exactly what and why. This feeling may activate analytical reasoning in the diagnostic process by stimulating a GP to formulate provisional hypotheses involving potentially serious outcomes. GPs may perceive a sense of reassurance, i.e. a secure feeling about the further management and course of a patient’s problem, even though they may not be certain about the actual diagnosis (Stolper et al 2009a, b)

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