Mercer University, College of Pharmacy, Atlanta, Georgia
Mercer University, College of Pharmacy, Atlanta, Georgia.
Am J Pharm Educ. 2022 Apr;86(4):8697. doi: 10.5688/ajpe8697. Epub 2021 Aug 12.
Clinical reasoning is integral to the provision of patient-centered care as outlined in the Pharmacists' Patient Care Process (PPCP). However, the PPCP was not created to foster clinical reasoning in student pharmacists and cannot be the sole tool used to characterize or cultivate these skills. This article describes elements of clinical reasoning, the relationship between clinical reasoning and PPCP, and concepts from the clinical reasoning literature that should inform the teaching of clinical reasoning skills. Key elements of the PPCP were identified in clinical reasoning definitions, but differences emerged. The literature supports clinical reasoning as a bidirectional, fluid process that is highly collaborative. Effective clinical reasoning requires multiple types of "thinking," interaction with others and the environment, self-assessment, and a tolerance for nuance or ambiguity. Teaching strategies can be used in the didactic and experiential setting to target the cognitive and contextual factors associated with clinical reasoning. Educators should consult the literature to enhance our understanding of clinical reasoning in seeking to teach, model, and foster these skills in our students. Future scholarship should include the development of models to support clinical reasoning within the profession of pharmacy, adoption and experimentation with clinical reasoning teaching techniques, and valuation of the utility of various assessment tools and processes.
临床推理是患者为中心的护理提供的必要组成部分，正如药剂师患者护理流程（PPCP）所概述的那样。然而，PPCP 的创建并不是为了培养学生药剂师的临床推理能力，也不能成为唯一用于描述或培养这些技能的工具。本文描述了临床推理的要素、临床推理与 PPCP 之间的关系，以及临床推理文献中的概念，这些都应该为临床推理技能的教学提供信息。PPCP 的关键要素在临床推理定义中被识别出来，但也存在差异。文献支持临床推理是一个双向、流畅的过程，高度协作。有效的临床推理需要多种类型的“思维”，与他人和环境的互动，自我评估，以及对细微差别或模糊性的容忍度。教学策略可以在理论和实践教学环境中使用，以针对与临床推理相关的认知和背景因素。教育工作者应该查阅文献，加深对临床推理的理解，以便在教学中寻求教授、模拟和培养学生的这些技能。未来的学术研究应包括开发支持药学专业临床推理的模型，采用和实验临床推理教学技术，以及评估各种评估工具和流程的实用性。
