Clinical Reasoning

Question 1

Define clinical reasoning.

Answer 1

a reflective process of inquiry & analysis carried out by a health professional in collaboration with the patient with the aim of understanding the patient, their context, and their clinical problem(s) in order to guide evidence-based practice

Question 2

What are the 3 elements of evidence-based practice?

Answer 2

1. best available research evidence
2. clinical experience
3. patient preferences & perspectives

Question 3

List the 8 clinical reasoning strategies described in the monograph.

Answer 3

1. Diagnostic
2. Narrative
3. Intervention Procedures
4. Interactive
5. Collaborative
6. Reasoning about Teaching / Patient Education
7. Predictive
8. Ethical

Question 4

Which type of reasoning strategy includes reasoning about what information to gather & how to interpret information from both the patient interview/interactions and physical examination?

Answer 4

Diagnostic Reasoning

Question 5

Which type of reasoning strategy involves establishing and validating an understanding of the “person” who is the patient & includes the patient’s illness experience, context, beliefs, and culture?

Answer 5

Narrative Reasoning

Question 6

Which type of reasoning strategy include the choice & administration of interventions?

Answer 6

Intervention Procedures Reasoning

Question 7

Which type of reasoning strategy includes strategic choices of approach & manner of interacting with patients?

Answer 7

Interactive Reasoning

Question 8

Which type of reasoning strategy involves approaches and strategies for educating patients & effective assessment of whether or not intended learning has occurred?

Answer 8

Reasoning about Teaching / Patient Education

Question 9

Which type of reasoning strategy involves the development of a prognosis & the consideration of what factors will influence a “worst case” vs “best case” scenario?

Answer 9

Predictive Reasoning

Question 10

Which type of reasoning strategy involves recognition of moral and pragmatic dilemmas in daily practice?

Answer 10

Ethical Reasoning

Question 11

Describe the reasoning error of “over-focus on early / superficial recognition”

Answer 11

acceptance of the validity of a diagnosis / clinical pattern identification based on a presentation’s superficial similarity to another familiar case

Question 12

Describe the reasoning error of “premature anchoring”

Answer 12

fixation on first impressions that is unaltered with new or conflicting information

Question 13

Describe the reasoning error of “premature closure”

Answer 13

acceptance of a diagnosis without challenge through adequate consideration of likely alternatives

Question 14

Describe the reasoning error of the “framing effect”

Answer 14

a decision is made based on whether the options are presented with positive or negative connotations (ex. “kills 99% of germs” vs “only 1% of germs survive”)

Question 15

Describe the reasoning error of “commission bias”

Answer 15

deciding to do something regardless of evidence that would contradict the decision

Question 16

Describe the reasoning error of an “extrapolation error”

Answer 16

inappropriately choosing to do something that was done successfully in another dissimilar situation or group

Question 17

Describe the reasoning error of “confirmation bias”

Answer 17

the tendency to look for, notice, and remember only the information that fits with pre-existing expectations (i.e. a favorite hypothesis or clinical pattern)

Question 18

Describe the reasoning error of “outcome bias”

Answer 18

the tendency for an overreliance on outcome information to indicate accuracy or quality of the clinical reasoning that determined the choice of intervention.

Question 19

List 3 common inductive clinical reasoning errors.

Answer 19

1. Superficial psychosocial assessment
2. Approaching narrative reasoning deductively
3. Either/Or Mentality

Question 20

Describe the inductive clinical reasoning error of “superficial psychosocial assessment”

Answer 20

patient does not volunteer or downplays personal factors so the clinician assumes they are not present and/or relevant; patient alludes to a personal factor (i.e. stress at home), but clinician does not follow up to establish patient’s perception of any relationship to physical problems

Question 21

Describe the inductive clinical reasoning error of “approaching narrative reasoning deductively”

Answer 21

clinician makes assumptions about how the patient might feel, perceive, or value various aspects of a situation and asks closed-ended questions to confirm or negate those assumptions, rather than asking open-ended questions.

Question 22

Describe the inductive clinical reasoning error of “either/or mentality”

Answer 22

the clinician views biopsychosocial
as either a “biological/physical presentation or a “psychosocial” presentation; clinician approaches a patient “either” with a primarily deductive reasoning approach if the presentation is judged to be more physical-impairment dominant, “or” with an inductive, narratively focused reasoning strategy if the presentation is judged to be more psychosocially
based

Question 23

Contrast deductive and inductive reasoning in a clinical context. Give examples of each.

Answer 23

• Deductive clinical reasoning: development and systematic testing of hypotheses & the subsequent ruling in/out based on the results of testing (ex. comparing passive vs active shoulder ROM to investigate a suspected diagnosis)
• Inductive clinical reasoning: eliciting data directly from patients via open-ended questions focused on patients’ interpretations of aspects of the situation (ex. asking a patient how she herself feels about having a torn meniscus during training for a regional competition)

Question 24

Does the following describe deductive reasoning or inductive reasoning?: “hypothesis is judged to be more likely to be true (confirmed) or less likely to be true (negated) by considering the results of the questioning, tests, and measures performed during the examination”

Answer 24

deductive reasoning

Question 25

List the 5 most common errors in applying research evidence to PT practice.

Answer 25

1. over-generalization 2. over-valuing a test finding 3. omission of quality assessment of literature 4. lack of scrutiny for outcome measure choice 5. not keeping up with the literature

Question 26

List the 3 most common errors in applying clinical experience/expertise to PT practice

Answer 26

1. lack of confidence 2. over-valuing clinical experience 3. inappropriate clinical pattern recognition

Question 27

List the 2 most common errors in applying patient preferences/perspectives to PT practice

Answer 27

1. making assumptions 2. lack of integration

Question 28

List the 3 most common errors in applying integration of EBP components to PT practice.

Answer 28

1. minimal inclusion of clinical experience/expertise 2. patient preference dominates 3. inadequate consideration of current research evidence

Question 29

List the components of the Five Microskills Model for mentoring.

Answer 29

1. obtain a commitment from the learner about what they think is happening with the patient's problem first (instead of a summary) 2. probe for underlying reasoning 3. teach/review general concepts, principles, and specific knowledge relevant to understanding the case 4. provide positive feedback about what the learner has done well 5. correct errors (as needed in the moment, for the benefit of the patient)