Takeaway
Improving clinical reasoning skills is a career-long journey where we feel like an expert one day and a novice the next. Commitment to growth and learning from mistakes are absolutely required.
Lifelong Learning in Clinical Excellence | January 4, 2024 | 1 min read
By Scott Wright, MD, Johns Hopkins Medicine
A 57 year-old female police officer comes to see you in your office with three weeks of chills, right wrist pain, hair loss, and tingling in her feet. What’s the diagnosis?
A few weeks ago, Dr. Steven Durning came to our hospital as this year’s “Dr. Dave Kern Visiting Professor.” As part of the visit, he spoke at medicine grand rounds about his area of expertise, the assessment of clinical reasoning.
While he was speaking, I thought of both my own self-assessment of my clinical reasoning skills and my ability to evaluate trainees. I’d just finished two weeks as attending on the wards with medical students, interns, and residents.
Here’s what I took away from his terrific presentation:
1. Clinical reasoning is complex, and assessing it is even more complex, largely because you can’t see what is going on in any person’s head. Usually, only the final decision about the diagnosis or management plan is “visible”/shared.
2. The terminology used to describe clinical reasoning is inconsistent and can lead to confusion (e.g. reasoning process, reasoning performance, outcome of reasoning, context of reasoning . . .).
3. An individual’s clinical reasoning skills may appear to be very different depending on the method or source of the data (e.g. oral presentation versus written note versus think-aloud exercise). On top of this, additional intra-personal variation may be due to (i) provider factors, (ii) patient factors, and (iii) setting factors, including things like the clinical context or sleep deprivation.
4. We often think about clinical reasoning with respect to making the correct diagnosis, however equally important may be “management reasoning,” which is the process of making decisions, including choices about treatment, follow-up visits, further testing, and allocation of limited resources.
Here are a few practical tips that will help me as a clinician and educator:
1. Genuinely commit to growth and improvement.
2. Learn from others.
3. Learn from mistakes/misinterpretations.
4. When things don’t add up, make additional observations (collect more data).
5. AI may be helpful in this space, but it can’t replace the skilled clinician who listens, asks thoughtful questions, performs the physical examination, and treats the patient with respect, dignity, and compassion.
This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.