Department of Internal Medicine, Unit Pharmacotherapy, Amsterdam UMC, Vrije Universiteit, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
Research and Expertise Centre in Pharmacotherapy Education (RECIPE), De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
BMC Med Educ. 2024 Nov 26;24(1):1360. doi: 10.1186/s12909-024-06310-4.
Despite efforts to improve undergraduate clinical pharmacology & therapeutics (CPT) education, prescribing errors are still made regularly. To improve CPT education and daily prescribing, it is crucial to understand how therapeutic reasoning works. Therefore, the aim of this study was to gain insight into the therapeutic reasoning process.
A narrative literature review has been performed for literature on cognitive psychology and diagnostic and therapeutic reasoning.
Based on these insights, The European Model of Therapeutic Reasoning has been developed, building upon earlier models and insights from cognitive psychology. In this model, it can be assumed that when a diagnosis is made, a primary, automatic response as to what to prescribe arises based on pattern recognition via therapy scripts (type 1 thinking). At some point, this response may be evaluated by the reflective mind (using metacognition). If it is found to be incorrect or incomplete, an alternative response must be formulated through a slower, more analytical and deliberative process, known as type 2 thinking. Metacognition monitors the reasoning process and helps a person to form new therapy scripts after they have chosen an effective therapy. Experienced physicians have more and richer therapy scripts, mostly based on experience and enabling conditions, instead of textbook knowledge, and therefore their type 1 response is more often correct.
Because of the important role of metacognition in therapeutic reasoning, more attention should be paid to metacognition in CPT education. Both trainees and teachers should be aware of the possibility to monitor and influence these cognitive processes. Further research is required to investigate the applicability of these insights and the adaptability of educational approaches to therapeutic reasoning.
尽管为改善本科生临床药理学与治疗学（CPT）教育付出了努力，但仍定期出现处方错误。为改善 CPT 教育和日常处方，了解治疗推理的工作方式至关重要。因此，本研究旨在深入了解治疗推理过程。
对认知心理学和诊断与治疗推理方面的文献进行了叙述性文献回顾。
基于这些见解，开发了欧洲治疗推理模型，该模型建立在早期模型和认知心理学的见解之上。在该模型中，可以假定在做出诊断后，会基于通过治疗方案（类型 1思维）进行模式识别而自动产生要开的药物。在某个时候，这种反应可能会通过反思思维（使用元认知）进行评估。如果发现它是不正确或不完整的，则必须通过较慢，更具分析性和深思熟虑的过程来制定替代反应，称为类型 2思维。元认知会监控推理过程，并帮助人们在选择有效的治疗方法后形成新的治疗方案。经验丰富的医生拥有更多且更丰富的治疗方案，这些方案主要基于经验和条件，而不是教科书知识，因此他们的类型 1反应通常更正确。
由于元认知在治疗推理中的重要作用，CPT 教育应更加关注元认知。培训生和教师都应该意识到可以监测和影响这些认知过程。需要进一步研究以调查这些见解的适用性以及对治疗推理的教育方法的适应性。
