Eva Kevin W
Program for Educational Research and Development, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario L8N 3Z5, Canada.
Med Educ. 2005 Jan;39(1):98-106. doi: 10.1111/j.1365-2929.2004.01972.x.
One of the core tasks assigned to clinical teachers is to enable students to sort through a cluster of features presented by a patient and accurately assign a diagnostic label, with the development of an appropriate treatment strategy being the end goal. Over the last 30 years there has been considerable debate within the health sciences education literature regarding the model that best describes how expert clinicians generate diagnostic decisions.
The purpose of this essay is to provide a review of the research literature on clinical reasoning for frontline clinical teachers. The strengths and weaknesses of different approaches to clinical reasoning will be examined using one of the core divides between various models (that of analytic (i.e. conscious/controlled) versus non-analytic (i.e. unconscious/automatic) reasoning strategies) as an orienting framework.
Recent work suggests that clinical teachers should stress the importance of both forms of reasoning, thereby enabling students to marshal reasoning processes in a flexible and context-specific manner. Specific implications are drawn from this overview for clinical teachers.
分配给临床教师的核心任务之一是让学生梳理患者呈现的一系列特征，并准确给出诊断标签，最终目标是制定出合适的治疗策略。在过去30年里，健康科学教育文献中就最能描述专家临床医生如何做出诊断决策的模型展开了大量辩论。
本文旨在为一线临床教师提供有关临床推理研究文献的综述。将以各种模型之间的核心分歧之一（即分析性（即有意识/可控）与非分析性（即无意识/自动）推理策略）作为导向框架，审视不同临床推理方法的优缺点。
近期研究表明，临床教师应强调两种推理形式的重要性，从而使学生能够以灵活且因地制宜的方式运用推理过程。本综述为临床教师得出了具体启示。
