“ We’re pretty sure it’s the West Nile virus.”. Assessment of Diagnostic Reasoning and Clinical Thought Chart Stimulated Recall. Clinical Judgment/Reasoning. The cognitive engine that drives problem-solving and decision-making. www.chinesenursing.org/openAccess/sn331/html/doc/cyber-M1_
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students.pdf clinical reasoning definition
Interest in gaining more information
Willing to invest energy in thinking the matter through
Possess the cognitive ability
“Bad Thinking” – “cognitive misers”
Chose to take mental shortcuts, engage in heuristic thinking,
without interest in “good thinking”Critical Thinking
Accurate “problem representation”
Generation of hypothesis
Search for and selection - illness script
Bowen JL. NEJM; 2006: 2217
¹ Arch Intern Med. 2005; 165: 1493.
78-year-old (ELDERLY) male for evaluation of a 2-week (SUBACUTE) history joint pain. Symptoms began 1 week after a cardiac catheterization (RECENT MEDICAL INTERVENTION). Both knees and one wrist (OLIGO-ARTICULAR). He has no fever, weight loss, or malaise (NON-SYSTEMIC). Recent labs are significant for an ESR of 50 (INFLAMMATORY).
Review this resident note. The resident is on a one month geriatric rotation.
Are there opportunities to explore the resident’s diagnostic reasoning?
Internal Consistency - Identify any disconnects in the history and physical.
S + P = O
S + P = O
Night float MR + CSR = Evaluation of trainee clinical thought/diagnostic reasoning and a documented educational experience on night float rotation