Yazdani Shahram, Hosseinzadeh Mohammad, Hosseini Fakhrolsadat
School of Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
J Adv Med Educ Prof. 2017 Oct;5(4):177-184.
Diagnosis lies at the heart of general practice. Every day general practitioners (GPs) visit patients with a wide variety of complaints and concerns, with often minor but sometimes serious symptoms. General practice has many features which differentiate it from specialty care setting, but during the last four decades little attention was paid to clinical reasoning in general practice. Therefore, we aimed to critically review the clinical reasoning models with a focus on the clinical reasoning in general practice or clinical reasoning of general practitioners to find out to what extent the existing models explain the clinical reasoning specially in primary care and also identity the gaps of the model for use in primary care settings.
A systematic search to find models of clinical reasoning were performed. To have more precision, we excluded the studies that focused on neurobiological aspects of reasoning, reasoning in disciplines other than medicine decision making or decision analysis on treatment or management plan. All the articles and documents were first scanned to see whether they include important relevant contents or any models. The selected studies which described a model of clinical reasoning in general practitioners or with a focus on general practice were then reviewed and appraisal or critics of other authors on these models were included. The reviewed documents on the model were synthesized.
Six models of clinical reasoning were identified including hypothetic-deductive model, pattern recognition, a dual process diagnostic reasoning model, pathway for clinical reasoning, an integrative model of clinical reasoning, and model of diagnostic reasoning strategies in primary care. Only one model had specifically focused on general practitioners reasoning.
A Model of clinical reasoning that included specific features of general practice to better help the general practitioners with the difficulties of clinical reasoning in this setting is needed.
诊断是全科医疗的核心。全科医生（GP）每天都会诊治有各种各样主诉和担忧的患者，症状往往较轻，但有时也很严重。全科医疗有许多区别于专科护理环境的特点，但在过去的四十年里，全科医疗中的临床推理很少受到关注。因此，我们旨在批判性地回顾临床推理模型，重点关注全科医疗中的临床推理或全科医生的临床推理，以了解现有模型在多大程度上解释了特别是初级保健中的临床推理，并找出该模型在初级保健环境中使用的差距。
进行了系统搜索以查找临床推理模型。为了更精确，我们排除了那些关注推理的神经生物学方面、医学以外学科的推理、治疗或管理计划的决策分析的研究。首先对所有文章和文档进行扫描，看它们是否包含重要的相关内容或任何模型。然后对所选的描述全科医生临床推理模型或重点关注全科医疗的研究进行回顾，并纳入其他作者对这些模型的评价或批评。对有关该模型的已审查文档进行综合。
确定了六种临床推理模型，包括假设演绎模型、模式识别、双过程诊断推理模型、临床推理路径、临床推理综合模型和初级保健中的诊断推理策略模型。只有一个模型专门关注全科医生的推理。
需要一个包含全科医疗特定特征的临床推理模型，以更好地帮助全科医生应对这种情况下临床推理的困难。
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