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Flashcards in Quiz 2 Deck (16):
1

1) What is clinical reasoning



















2) Is clinical reasoning synonymous with clinical decision making? Are they different?

1) ** Clinical reasoning can be summarized as the THINKING and DECISION-MAKING of a health care provider in clinical practice.

Clinical Reasoning is the process by which a therapist interacts with a patient, collecting information, generating and testing hypotheses, and determining optimal diagnosis and treatment based on the information obtained.

"A process of reflective inquiry, in collaboration with a patient or family, which seeks to promote a deep and contextually relevant understanding of the clinical problem, in order to provide a sound basis for clinical intervention."

*** Clinical reasoning can be defined as
the sum of the critical THINKING and DECISION-MAKING processes associated with clinical practice within the health professions.

2) YES. Clinical reasoning is defined as the THINKING or judgment behind one’s action, and clinical
decision-making is the ACTION (decision) on this process.

2

What are factors that influence or are part of clinical reasoning:

- Reflection
- Mutual decision making
- Consultation of patient and family
- Patient context or life situation
- PROFESSION (discipline)-SPECIFIC knowledge
- Metacognitive skills
- Clinician judgement / beliefs
- Consult other health professionals
- Clinical experience
- Clinician knowledge and analyzing data (from eval)
- Clinical decision (action)

3

Novice (rookie) clinicians rely on what for clinical reasoning/decisions:

Experienced clinicians (experts) rely on what for clinical reasoning/decisions:

Novice clinicians: are more likely to use a hypothetico-DEDUCTIVE reasoning process

Expert clinicians: usually rely on PATTERNS OF RECOGNITION (experience) to solve patient problems. INDUCTIVE reasoning.

4

What is hypothetico-deductive reasoning:


What is Pattern Recognition (inductive reasoning):

Do novices or expert clinicians use hypothetico-deductive reasoning?

Generation of a hypothesis based upon results of tests and measures, followed by testing this hypothesis.

Quick retrieval of information from well structured knowledge based upon previous clinical experience.

Novices (rookies)

5

Difference between deductive reasoning vs. inductive reasoning:

Deductive reasoning moves from generalized principles that are known to be true to a true and specific conclusion.

Inductive reasoning moves from specific instances into a generalized conclusion

6

T or F: Reflection (whether written, thought, or verbal),
is a necessary and powerful tool in the development of clinical reasoning skills

True

7

What is the One Minute CI

Capitalizes on teaching moments and requires the learner to form opinions regarding specific clinical problems.

• Step 1: Ask the learner to state an opinion about the issues presented in the clinical case.
• Step 2: Ask the learner for evidence to support this opinion.
• Step 3: The CI then provides the learner with specific information that can be directly applied to the clinical problem at hand.
• Step 4: The CI reinforces the learner’s correct assumptions and actions and addresses any mistakes or misconceptions.

8

Review...

1) What is Deductive Reasoning:






2) What is Inductive Reasoning:












3) Should you favor one over the other?

4) Which one is more structured?

5) Which one relies on clinical experience or recognition of familiar patterns?

1) Deductive: Deductive reasoning strategies include use
of the hypothetico-deductive method and emphasize HYPOTHESIS GENERATION on the basis of information gathered from the patient through interviewing and questioning to develop an initial hypothesis. Using a deductive reasoning approach, additional information including results from tests and measures is collected and interpreted in a cyclical process to disprove or confirm a hypothesis or diagnosis by comparing options.

2) Inductive: inductive reasoning strategies typically involve RECOGNITION OF FAMILIAR CLINICAL PATTERNS (from experience) and identification of the patient-specific contextual factors, ambiguities, and challenges that affect the care of an individual patient without actively comparing and contrasting options.

Deductive reasoning = hypothetico-deductive (hypothesis)

Inductive reasoning = pattern recognition (experience)

3) Should balance both.

4) Deductive (uses a structure like ICF model or patient management model to guide clinical thinking and decision making)

5) Inductive

9

__________ reasoning strategies usually require patient experience and familiarity with a situation to form a clinical pattern.

Inductive

10

PT education, and education in general, often
emphasizes evaluation of student performance that is
focused on the ___________. This is in contrast to
preparing students to identify and solve problems through the inherent uncertainties of __________________.

Single correct answer

Clinical practice

In other words ... it is not black and white, or one correct answer. There may be many correct approaches, but the thought process (clinical reasoning) behind it is what is important and needs to be taught and practiced (in a clinical setting, not a classroom).

11

What was the purpose of article 2:

The purpose of this article is to provide academic faculty and clinical instructors with an overview of various pedagogical strategies and tools that can be used to teach students clinical reasoning skills and to facilitate the development of both deductive and inductive reasoning strategies in pediatric PT practice.

12

T or F: experience and exposure to clinical practice
alone are sufficient to develop clinical reasoning
skills?

False

Students must learn to consistently reflect on and learn from specific patient related contextual situations in order to transform their critical thinking structure and process in a progression toward clinical expertise.

13

Why would an educator or CI want to have their student reflect?

Reflection not only allows students to contemplate and ponder key aspects of a specific patient-related experience, but also offers educators a way to “get the inside out” and see what students are thinking.

14

Difference between:

Reflection-on-action
Reflection-in-action
Reflection-for-action


Which one is used more by experts, which is used more by novices?

- Reflection-on-action: AFTER the experience occurs (looking BACK and reflecting)

- Reflection-in-action: Reflecting or making changes DURING real time (in the moment reflection / clinical reasoning)

- Reflection-for-action: Anticipates change for FUTURE
interactions

Experts: FOR
Novices: ON
(IN action is in the middle)

15

Explain the most commonly used DEDUCTIVE reasoning frameworks:






Explain the most commonly used INDUCTIVE reasoning framework:

DEDUCTIVE:
1) ICF Model

2) Clinical algorithms: HOAC is a clinical framework that provides a systematic, step-wise guide to clinical reasoning in pediatric PT practice. Student has to consider various factors effecting child and thus clinical decision.

INDUCTIVE:
1) Clinical Narratives: A clinical narrative is a form
of reflection that involves recollection and description of
an actual clinical event that has some significance because the event allowed learning or comprehension to occur. The inclusion of feelings, specific details,
and the students’ thoughts throughout the narrative
description is encouraged. In the narrative, students describe what they know about the clinical situation along
with the areas with which they struggle or have difficulties.
The CI can use the narrative to identify strengths and weaknesses in clinical reasoning skills.

2) Open ended questions

3) Reflection (in or on or for)

16

Novice clinicians and students are more likely to use
_________ methods which provide MORE organization and structure.

Experienced and expert clinicians are more likely to use
_______ methods which have LESS structure and guidance

Deductive



Inductive