Institute of Mental Health, Singapore.
Int J Med Educ. 2023 Aug 31;14:108-116. doi: 10.5116/ijme.64d9.e64b.
The current study sought to explain how different professional experiences led Singaporean psychiatrists to alter their clinical reasoning processes as their careers evolved from psychiatry residents to senior consultant psychiatrists.
The current qualitative study interviewed 26 clinicians at various stages of their psychiatric career, spanning residents to senior psychiatrists. The authors used a constructivist grounded theory approach to structure the collection and analysis of data. Analyses produced a dense theoretical explanation rooted in the experiences of participants.
Several differences emerged between the way psychiatry residents and senior psychiatrists explained their reasoning process and the experiences on which they based their preference. Residents preferred using deductive logic-driven frameworks that were diagnosis-centric, because of the pressures they experienced during their training and assessments. Senior psychiatrists emphasized a more holistic and problem-centric approach. Participants attributed the changes that occurred over time to practical experiences, such as their greater clinical responsibility and independence, and individual experiences, such as growing sensitivity to the clinical reasoning process or their growing propensity for professional reflectiveness. These changes manifest as an increase in repertoire and flexibility in deployment of different clinical reasoning strategies.
It is important for trainees to be aware of the deductive and inductive modes of clinical reasoning during supervision and to be comfortable with shifting clinical focus from diagnoses to specific individual problems. Training programs should provide and plan adequate longitudinal clinical exposure to develop clinical reasoning abilities in a way that allows consequences of decisions to be explored. Continued faculty development to ease the diversification of clinical reasoning skills should be encouraged, as should reflectivity in the learners during clinical supervision.
本研究旨在解释不同的专业经验如何导致新加坡精神病医生在其职业生涯中从住院医师转变为高级顾问精神病医生时改变其临床推理过程。
本定性研究采访了 26 名处于不同职业阶段的临床医生，包括住院医师和高级精神病医生。作者采用建构主义扎根理论方法来构建数据的收集和分析。分析产生了一个根植于参与者经验的密集理论解释。
精神病住院医师和高级精神病医生在解释其推理过程和依据的经验方面存在一些差异。住院医师更喜欢使用以诊断为中心的演绎逻辑驱动框架，因为他们在培训和评估期间面临压力。高级精神病医生则强调更全面和以问题为中心的方法。参与者将随着时间的推移发生的变化归因于实际经验，例如他们更大的临床责任和独立性，以及个人经验，例如对临床推理过程的敏感性增加或他们对专业反思的倾向增加。这些变化表现为不同临床推理策略的应用范围和灵活性增加。
在监督过程中，培训生了解临床推理的演绎和归纳模式很重要，并且能够将临床重点从诊断转移到特定的个体问题上。培训计划应提供和规划足够的纵向临床接触，以允许探索决策的后果。应鼓励继续发展教师的能力，以减轻临床推理技能的多样化，并鼓励学习者在临床监督中进行反思。
