Parodis Ioannis, Andersson Lina, Durning Steven J, Hege Inga, Knez Jure, Kononowicz Andrzej A, Lidskog Marie, Petreski Tadej, Szopa Magdalena, Edelbring Samuel
Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, 171 76 Stockholm, Sweden.
Department of Rheumatology, Faculty of Medicine and Health, Örebro University, 702 81 Örebro, Sweden.
Int J Environ Res Public Health. 2021 Oct 25;18(21):11202. doi: 10.3390/ijerph182111202.
Clinical reasoning entails the application of knowledge and skills to collect and integrate information, typically with the goal of arriving at a diagnosis and management plan based on the patient's unique circumstances and preferences. Evidence-informed, structured, and explicit teaching and assessment of clinical reasoning in educational programs of medical and other health professions remain unmet needs. We herein summarize recommendations for clinical reasoning learning objectives (LOs), as derived from a consensus approach among European and US researchers and health professions educators. A four-step consensus approach was followed: (1) identification of a convenience sample of the most relevant and applied national LO catalogues for health professions educational programs (N = 9) from European and US countries, (2) extraction of LOs related to clinical reasoning and translation into English, (3) mapping of LOs into predefined categories developed within the Erasmus+ Developing, implementing, and disseminating an adaptive clinical reasoning curriculum for healthcare students and educators (DID-ACT) consortium, and (4) synthesis of analysis findings into recommendations for how LOs related to clinical reasoning could be presented and incorporated in LO catalogues, upon consensus. Three distinct recommendations were formulated: (1) make clinical reasoning explicit, (2) emphasize interprofessional and collaboration aspects of clinical reasoning, and (3) include aspects of teaching and assessment of clinical reasoning. In addition, the consortium understood that implementation of bilingual catalogues with English as a common language might contribute to lower heterogeneity regarding amount, structure, and level of granularity of clinical reasoning LOs across countries. These recommendations will hopefully motivate and guide initiatives towards the implementation of LOs related to clinical reasoning in existing and future LO catalogues.
临床推理需要运用知识和技能来收集和整合信息,其目标通常是根据患者的独特情况和偏好得出诊断和管理计划。在医学及其他卫生专业的教育项目中,以证据为基础、结构化且明确的临床推理教学与评估仍是未得到满足的需求。我们在此总结了有关临床推理学习目标(LOs)的建议,这些建议源自欧洲和美国研究人员及卫生专业教育工作者的共识方法。遵循了四步共识方法:(1)从欧洲和美国国家的卫生专业教育项目中识别出最相关且应用广泛的国家LO目录的便利样本(N = 9);(2)提取与临床推理相关的LO并翻译成英文;(3)将LO映射到伊拉斯谟+为医学生和教育工作者开发、实施和传播适应性临床推理课程(DID - ACT)联盟内制定的预定义类别中;(4)经共识后将分析结果综合为关于如何在LO目录中呈现和纳入与临床推理相关的LO的建议。制定了三项不同的建议:(1)明确临床推理;(2)强调临床推理的跨专业和协作方面;(3)纳入临床推理的教学和评估方面。此外,该联盟认为实施以英语为通用语言的双语目录可能有助于降低各国临床推理LO在数量、结构和粒度水平上的异质性。这些建议有望激励和指导在现有及未来的LO目录中实施与临床推理相关的LO的举措。