The challenge of clinical reasoning in chronic multimorbidity: time and interactions in the Health Issues Network model.

Abstract

The increasing prevalence of multimorbidity requires new theoretical models and educational approaches to develop physicians' ability to manage multimorbidity patients. The Health Issues Network (HIN) is an educational approach based on a graphical depiction of the evolutions over time of the concurrent health issues of a patient andoftheir interactions. From a theoretical point of view,theHINapproach is rooted in Prigogine's vision ofthe "becoming" of the events and in the concept ofknowledge organization, intended as the process of storingand structuring of information in a learner's mind.The HINapproach allows to design clinical exercises tofosterlearners' ability to detect evolutionary paths and interactions among health issues. Recent findings of neuroscience support the expectation that interpreting, completing, and creating diagrams depicting complex clinical cases improves the "sense of time", as a fundamental competence inthe management of multimorbidity. The application of the HIN approach is expected to decrease the risk of errors in themanagement of multimorbidity patients. The approach isstill under validation, both for undergraduate students and for the continuous professional development of physicians.