Cutrer William B, Sullivan William M, Fleming Amy E
Vanderbilt University School of Medicine, Monroe Carell Jr. Children's Hospital at Vanderbilt, 2200 Children's Way, 5121 Doctor's Office Tower, Nashville, TN 37232.
Curr Probl Pediatr Adolesc Health Care. 2013 Oct;43(9):248-57. doi: 10.1016/j.cppeds.2013.07.005.
Clinical reasoning serves as a crucial skill for all physicians regardless of their area of expertise. Helping trainees develop effective and appropriate clinical reasoning abilities is a central aim of medical education. Teaching clinical reasoning however can be a very difficult challenge for practicing physicians. Better understanding of the different cognitive processes involved in physician clinical reasoning provides a foundation from which to guide learner development of effective reasoning skills, while pairing assessment of learner reasoning abilities with understanding of different improvement strategies offers the opportunity to maximize educational efforts for learners. Clinical reasoning errors often can occur as a result of one of four problems in trainees as well as practicing physicians; inadequate knowledge, faulty data gathering, faulty data processing, or faulty metacognition. Educators are encouraged to consider at which point a given learner's reasoning is breaking down. Experimentation with different strategies for improving clinical reasoning can help address learner struggles in each of these domains. In this chapter, various strategies for improving reasoning related to knowledge acquisition, data gathering, data processing, and clinician metacognition will be discussed. Understanding and gaining experience using the different educational strategies will provide practicing physicians with a toolbox of techniques for helping learners improve their reasoning abilities.
临床推理对所有医生来说都是一项至关重要的技能，无论其专业领域如何。帮助实习生培养有效且恰当的临床推理能力是医学教育的核心目标。然而，对执业医生而言，教授临床推理可能是一项极具挑战性的任务。更好地理解医生临床推理中涉及的不同认知过程，为指导学习者发展有效的推理技能奠定了基础，而将对学习者推理能力的评估与对不同改进策略的理解相结合，为最大限度地提高学习者的教育成效提供了契机。临床推理错误通常可能是由于实习生以及执业医生存在的四个问题之一导致的：知识不足、数据收集有误、数据处理有误或元认知有误。鼓励教育工作者思考特定学习者的推理在哪个环节出现了问题。尝试不同的改善临床推理的策略有助于解决学习者在这些领域中的困难。在本章中，将讨论与知识获取、数据收集、数据处理和临床医生元认知相关的各种改善推理的策略。理解并通过使用不同的教育策略积累经验，将为执业医生提供一系列帮助学习者提高推理能力的技巧。
