1.1 Introduction

Question 1

Define an Iterative process

Answer 1

gathering information about the patient and searching for ‘illness script’ that fits

Question 2

Fill in the image showing an iterative process

Answer 2

Question 3

What are the 4 key steps in clinical reasoning

Answer 3

1) organise and activate knowledge
2) accurate summary statement: helps find data match (illness script)
3) aware of heuristics (Fast, efficient decisions BUT may result in loss of accuracy)
4) awareness of medical errors

Question 4

What are illness scripts and give 3 factors that must be included

Answer 4

A way to organise “typical presentations”

• Risk factors/ epidemiology
• Pathophysiology
• Clinical features

Question 5

Define clinical reasoning

Answer 5

The decision making process involved in clinical practice

Clinicians ability to make decisions based on available information from history, examination and investigations, in an environment of clinical uncertainty.

Question 6

Give 4 skills that a practioner may use in clinical reasoning

Answer 6

Question 7

In clinical reasoning what type of error is common?

Answer 7

Because diagnostic error is common which can cause substantial harm

Sound clinical reasoning is linked to patient safety and quality of care

Question 8

Give 4 factors influencing clinical decisions

Answer 8

1. the clinical problem
2. patient’s interests, perspective
3. clinician’s interests, perspective
4. work team context
5. organisational context
6. sociocultural context

Question 9

Give 3 types of diagnostic error and explain each

Answer 9

1) No fault:

• unusual presentation
• missing information

2) System error:

• tests/results not available
• poor supervision of junior staff
• errors in processes
• excessive workload

3) Human error

• information gathering faulty
• inadequate reasoning

Question 10

What is meant by ‘Dual process theory’ and explain the 2 types

Answer 10

Dual process theory shows how thought can arise as a result of two different processes

Types 1: rapid, pattern recognising way of thinking

Types 2: slower, more deliberate decision making process

Question 11

Illness scripts involves which type of duel process theory and why?

Answer 11

Type 1: typical presentations of common conditions- pattern recognition

Question 12

Iterative hypothesis testing involves which type of duel process theory and why?

Answer 12

Type 2: must identify features that do not “fit” and test the assumptions made

Question 13

Why is Iterative hypothesis testing important?

Answer 13

helps to avoid prematurely settling on a diagnosis, problem list can be utilise

Question 14

What is meant by cognitive bias?

In which type of duel process theory does this occur?

Answer 14

Tendency to respond in a certain way by subconscious deviations in judgement. Can lead to inaccurate judgement and/ or illogical interpretations

Occurs in both type 1 and type 2 thinking

Question 15

Give 4 examples of human bias and explain each

Answer 15

1) Anchoring: tendency to latch onto first piece of information offered

2) Confirmation bias: tendency to look for confirming evidence that supports initial diagnosis, and ignores evidence that refutes it

3) Premature closure: make diagnosis before information is gathered or verified

4) Search sacrificing: stop searching because you find a cause that fits

Question 16

Give 3 things we must ask ourselfs as clinicians to prevent bias

Answer 16

1) what else could it be?
2) does anything not fit in this history?
3) could two things be going on?

Question 17

Give 4 clinical strategies to reduce biases and explain each

Answer 17

1) Hx and examination: systematic gathering of data

2) DDx: forces consideration of other diagnoses

3) Clinical prediction rules: force statistical assessment of patient symptoms, signs and other data

4) EBM: establishes objective scientific data to support analytic decision making

Question 18

Give 4 ways to Improve diagnostic accuracy for yourself (Mr FD)

Answer 18

1) FEEDBACK actively seek feedback
2) DELIBERATE PRACTICE to achieve your maximum potential
3) REFLECTION helps to develop self awareness, reduces bias
4) METACOGNITION think about how you think and be more self aware