Centre for Education Research and Innovation, Department of Medicine, University of Western Ontario, Schulich School of Medicine and Dentistry, London, Ontario, Canada.
Acad Med. 2013 Mar;88(3):390-7. doi: 10.1097/ACM.0b013e31827fc58d.
The clinical reasoning literature focuses on how physicians reason while making decisions, rather than on what they reason about while performing their clinical tasks. In an attempt to provide a common language for discussing, teaching, and researching clinical reasoning, the authors undertook the task of developing a unified list of physicians' reasoning tasks, or what they reason about, during clinical encounters.
The authors compiled an initial list of 20 reasoning tasks based on the literature from four content areas--clinical reasoning, communications, medical errors, and clinical guidelines. In the summer and fall of 2010, they surveyed a purposive sample of 46 international experts in clinical reasoning and communications. From the results of the first survey, the authors refined their list of reasoning tasks, then resurveyed 22 of the original participants. From the results of the second survey, they further refined their list and validated the inclusion of the reasoning tasks.
Twenty-four of 46 (52%) and 15 of 22 (65%) participants completed the first- and second-round surveys, respectively. Following the second-round survey, the authors' list included 24 reasoning tasks, and a clinical example corresponding to each, that fell into four broad categories: framing the encounter (3), diagnosis (8), management (11), and self-reflection (2).
The development of this unified list represents a first step in offering a vocabulary for discussing, reflecting on, teaching, and studying physicians' reasoning tasks during clinical encounters.
临床推理文献侧重于医生在做决策时的推理方式，而不是他们在执行临床任务时的推理内容。为了提供一个讨论、教学和研究临床推理的通用语言，作者承担了制定一份统一的医生推理任务清单的任务，即他们在临床接触期间所推理的内容。
作者根据来自临床推理、沟通、医疗错误和临床指南四个内容领域的文献，编制了一份最初包含 20 项推理任务的清单。在 2010 年夏季和秋季，他们对 46 名国际临床推理和沟通专家进行了有针对性的调查。根据第一次调查的结果，作者对他们的推理任务清单进行了修改，然后对最初的 22 名参与者进行了重新调查。根据第二次调查的结果，他们进一步修改了清单，并验证了推理任务的纳入。
在第一次和第二次调查中，分别有 46 名参与者中的 24 名（52%）和 22 名中的 15 名（65%）完成了调查。在第二轮调查之后，作者的清单包括 24 项推理任务，以及每个任务对应的一个临床示例，这些任务分为四大类：接触框架（3 项）、诊断（8 项）、管理（11 项）和自我反思（2 项）。
这份统一清单的制定代表了提供一个讨论、反思、教学和研究医生在临床接触期间推理任务的词汇的第一步。
