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重新思考临床决策以改善临床推理。

Rethinking clinical decision-making to improve clinical reasoning.

作者信息

Corrao Salvatore, Argano Christiano

机构信息

Department of Internal Medicine, National Relevance and High Specialization Hospital Trust ARNAS Civico, Palermo, Italy.

Dipartimento di Promozione della Salute Materno Infantile, Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro" (PROMISE), University of Palermo, Palermo, Italy.

出版信息

Front Med (Lausanne). 2022 Sep 8;9:900543. doi: 10.3389/fmed.2022.900543. eCollection 2022.

Abstract

Improving clinical reasoning techniques is the right way to facilitate decision-making from prognostic, diagnostic, and therapeutic points of view. However, the process to do that is to fill knowledge gaps by studying and growing experience and knowing some cognitive aspects to raise the awareness of thinking mechanisms to avoid cognitive errors through correct educational training. This article examines clinical approaches and educational gaps in training medical students and young doctors. The authors explore the core elements of clinical reasoning, including metacognition, reasoning errors and cognitive biases, reasoning strategies, and ways to improve decision-making. The article addresses the dual-process theory of thought and the new Default Mode Network (DMN) theory. The reader may consider the article a first-level guide to deepen how to think and not what to think, knowing that this synthesis results from years of study and reasoning in clinical practice and educational settings.

摘要

从预后、诊断和治疗的角度来看,改进临床推理技术是促进决策的正确途径。然而,实现这一目标的过程是通过学习、积累经验以及了解一些认知方面的知识来填补知识空白,从而提高对思维机制的认识,通过正确的教育培训避免认知错误。本文探讨了培训医学生和年轻医生的临床方法和教育差距。作者们探究了临床推理的核心要素,包括元认知、推理错误和认知偏差、推理策略以及改善决策的方法。本文还论述了思维的双过程理论和新的默认模式网络(DMN)理论。读者可以将本文视为一级指南,以深入了解如何思考而非思考什么,要知道这一综述是多年临床实践和教育环境中的研究与推理的成果。

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