Abstract
ObjectivesIn clinical reasoning, clinicians need to switch between automatic and effortful reasoning to solve both routine and non‐routine problems. This requires the ability to recognise when a problem is non‐routine and adapt one's reasoning mode accordingly, that is to ‘slow down’ the reasoning process. In the current study, we explored the process of these transitions between automatic and effortful reasoning by radiologists who performed ultrasound examinations during consultations at the polyclinic.MethodsManifestations of slowing down in clinical reasoning were explored in 41 out‐patient consultations performed by five radiologists. Interviews before and after the consultations were combined with observations during the consultations to obtain proactively planned triggers, slowing down manifestations and situationally responsive initiators. Transcripts of the interviews and field notes of the observations were coded. The constant comparative method was used to classify slowing down manifestations.ResultsIn thirteen of the 41 consultations, slowing down moments were observed. Four manifestations of slowing down were identified: shifting, checking, searching and focusing. These manifestations mainly differed in how long radiologists maintained effortful reasoning, varying from very short periods (shifting and checking) to sustained periods (searching and focusing). Unexpected patient statements and ambiguous ultrasound images initiated the slowing down moments.DiscussionThe results from this study contribute to understanding how clinicians transition from automatic to effortful reasoning. Also, this study revealed two sources of initiators of this transition in radiologists’ consultations: statements made by the patient and conflicting or ambiguous visual information, in this case from ultrasound images. Natural variations in patient statements and visual information can be used as input of what might be meaningful variation in the domain of radiology education to support expertise development.
Highlights
Clinical reasoning is at the heart of clinical expertise
We identify and describe the transitions from the routine to the more effortful mode of clinical reasoning by radiologists during a consultation at the polyclinic
We examined radiologists’ outpatient consultations during which an ultrasound examination was performed over a period of one month
Summary
According to dual-process theory, doctors rely on two modes of reasoning when diagnosing a patient: a near-automatic pattern detection mode and an effortful analytical mode.[1] In the latter mode, biomedical knowledge might be addressed, additional information can be gathered, or the current problem is actively compared to past experiences in order to fuel problem-solving, especially in non-routine cases.[2] Identifying whether a problem is routine or not, and adapting one's reasoning mode is of key importance for accurate diagnosis.[3]. In case of non-routine situations, such as problems with conflicting, unexpected or ambiguous information, clinicians need to make a transition from automatic to deliberate, analytical reasoning.[6]
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