Ng Isaac K S, Goh Wilson G W, Lim Tow Keang
Department of Medicine, 59053 National University Hospital, Singapore.
Department of Medicine, Division of Infectious Diseases, 59053 National University Hospital, Singapore.
Diagnosis (Berl). 2024 Dec 10;12(2):182-188. doi: 10.1515/dx-2024-0169. eCollection 2025 May 1.
Clinical reasoning is a quintessential aspect of medical training and practice, and is a topic that has been studied and written about extensively over the past few decades. However, the predominant conceptualisation of clinical reasoning has insofar been extrapolated from cognitive psychological theories that have been developed in other areas of human decision-making. Till date, the prevailing model of understanding clinical reasoning has remained as the dual process theory which views cognition as a dichotomous two-system construct, where intuitive thinking is fast, efficient, automatic but error-prone, and analytical thinking is slow, effortful, logical, deliberate and likely more accurate. Nonetheless, we find that the dual process model has significant flaws, not only in its fundamental construct validity, but also in its lack of practicality and applicability in naturistic clinical decision-making. Instead, we herein offer an alternative Bayesian-centric, intuitionist approach to clinical reasoning that we believe is more representative of real-world clinical decision-making, and suggest pedagogical and practice-based strategies to optimise and strengthen clinical thinking in this model to improve its accuracy in actual practice.
临床推理是医学培训与实践的一个典型方面，也是过去几十年来被广泛研究和著述的一个主题。然而，临床推理的主流概念化迄今为止一直是从人类决策其他领域所发展出的认知心理学理论中推断而来的。到目前为止，理解临床推理的主流模型仍然是双过程理论，该理论将认知视为一种二分的双系统结构，其中直觉思维快速、高效、自动但容易出错，而分析思维缓慢、费力、合乎逻辑、深思熟虑且可能更准确。尽管如此，我们发现双过程模型存在重大缺陷，不仅在其基本结构效度方面，而且在其自然主义临床决策中的实用性和适用性方面也存在不足。相反，我们在此提供一种以贝叶斯为中心的、直觉主义的临床推理方法，我们认为这种方法更能代表现实世界中的临床决策，并提出基于教学和实践的策略，以优化和强化该模型中的临床思维，从而提高其在实际实践中的准确性。
