Trowbridge Robert L, Olson Andrew P J
Department of Medicine, Maine Medical Center, 22 Bramhall Street, Portland, ME 04102, USA, Phone: +(207) 662-4618.
Tufts University School of Medicine, Boston, MA, USA.
Diagnosis (Berl). 2018 Mar 28;5(1):11-14. doi: 10.1515/dx-2018-0004.
Diagnostic reasoning is one of the most challenging and rewarding aspects of clinical practice. As a result, facility in teaching diagnostic reasoning is a core necessity for all medical educators. Clinician educators' limited understanding of the diagnostic process and how expertise is developed may result in lost opportunities in nurturing the diagnostic abilities of themselves and their learners. In this perspective, the authors describe their journeys as clinician educators searching for a coherent means of teaching diagnostic reasoning. They discuss the initial appeal and immediate applicability of dual process theory and cognitive biases to their own clinical experiences and those of their trainees, followed by the eventual and somewhat belated recognition of the importance of context specificity. They conclude that there are no quick fixes in guiding learners to expertise of diagnostic reasoning, but rather the development of these abilities is best viewed as a long, somewhat frustrating, but always interesting journey. The role of the teacher of clinical reasoning is to guide the learners on this journey, recognizing true mastery may not be attained, but should remain a goal for teacher and learner alike.
诊断推理是临床实践中最具挑战性且最有意义的方面之一。因此,教授诊断推理的能力是所有医学教育工作者的核心必备技能。临床医生教育工作者对诊断过程以及专业技能如何形成的理解有限,这可能导致在培养自身及学生诊断能力方面错失机会。从这个角度来看,作者描述了他们作为临床医生教育工作者寻找连贯的诊断推理教学方法的历程。他们讨论了双加工理论和认知偏差对他们自己及学生临床经验的初步吸引力和直接适用性,随后最终且有点迟地认识到情境特异性的重要性。他们得出结论,在引导学习者掌握诊断推理专业技能方面没有捷径可走,相反,这些能力的发展最好被视为一段漫长、有点令人沮丧但始终有趣的旅程。临床推理教师的作用是在这段旅程中引导学习者,认识到可能无法实现真正的精通,但这应该始终是教师和学习者共同的目标。