Lincoln Medical School, University of Lincoln, Lincoln, UK.
Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, UK.
Br J Hosp Med (Lond). 2024 Jul 30;85(7):1-8. doi: 10.12968/hmed.2024.0052. Epub 2024 Jul 24.
Clinical reasoning is fundamental for effective clinical practice. Traditional consultation models for teaching clinical reasoning or conventional approaches for teaching students how to make a diagnosis or management plan that rely on learning through observation only, are increasingly recognised as insufficient. There are also many challenges to supporting learners in developing clinical reasoning over time as well as across different clinical presentations and contexts. These challenges are compounded by the differences in how experts and novices make sense of clinical information, and the different cognitive processes each use when processing and communicating this information using precise medical language. Diagnostic errors may be due to cognitive biases but also, in a majority of cases, due to a lack of clinical knowledge. Therefore, effective educational strategies to develop clinical reasoning include identifying learners' knowledge gaps, using worked examples to prevent cognitive overload, promoting the use of key features and practising the construction of accurate problem representations. Deliberate reflection on diagnostic justification is also recommended, and overall, contributes to a growing number of evidence-based and theory-driven educational interventions for reducing diagnostic errors and improving patient care.
临床推理是有效临床实践的基础。传统的临床推理教学咨询模式或传统的教学方法，仅依靠观察来学习如何做出诊断或管理计划，这些方法正逐渐被认为是不够的。随着时间的推移，以及在不同的临床表现和背景下，支持学习者发展临床推理也存在许多挑战。专家和新手理解临床信息的方式不同，以及在使用精确的医学语言处理和交流信息时各自使用的不同认知过程，也使这些挑战更加复杂。诊断错误可能是由于认知偏差造成的，但在大多数情况下，也可能是由于缺乏临床知识。因此，发展临床推理的有效教育策略包括确定学习者的知识差距，使用示例来防止认知过载，促进关键特征的使用和练习准确问题表示的构建。建议对诊断理由进行深思熟虑的反思，总体上有助于越来越多基于证据和理论的教育干预措施的实施，以减少诊断错误并改善患者护理。
