Pinnock Ralph, Welch Paul
Child and Adolescent Health, James Cook University, Townsville, Queensland, Australia.
J Paediatr Child Health. 2014 Apr;50(4):253-7. doi: 10.1111/jpc.12455. Epub 2013 Dec 23.
Errors in clinical reasoning continue to account for significant morbidity and mortality, despite evidence-based guidelines and improved technology. Experts in clinical reasoning often use unconscious cognitive processes that they are not aware of unless they explain how they are thinking. Understanding the intuitive and analytical thinking processes provides a guide for instruction. How knowledge is stored is critical to expertise in clinical reasoning. Curricula should be designed so that trainees store knowledge in a way that is clinically relevant. Competence in clinical reasoning is acquired by supervised practice with effective feedback. Clinicians must recognise the common errors in clinical reasoning and how to avoid them. Trainees can learn clinical reasoning effectively in everyday practice if teachers provide guidance on the cognitive processes involved in making diagnostic decisions.
尽管有循证指南和技术进步，临床推理中的失误仍导致了大量的发病和死亡情况。临床推理专家常常运用无意识的认知过程，除非他们解释自己的思考方式，否则自己也并未意识到这些过程。理解直觉和分析性思维过程可为教学提供指导。知识的存储方式对于临床推理专业技能至关重要。课程设计应使学员以与临床相关的方式存储知识。临床推理能力是通过有有效反馈的监督实践获得的。临床医生必须认识到临床推理中的常见失误以及如何避免这些失误。如果教师能就诊断决策中涉及的认知过程提供指导，学员就能在日常实践中有效地学习临床推理。
