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Contextual factors and clinical reasoning: differences in diagnostic and therapeutic reasoning in board certified versus resident physicians.

Abstract The impact of context on the complex process of clinical reasoning is not well understood. Using situated cognition as the theoretical framework and videos to provide the same contextual "stimulus" to all participants, we examined the relationship between specific contextual factors on diagnostic and therapeutic reasoning accuracy in board certified internists versus resident physicians.
PMID
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Authors

Mayor MeshTerms

Physicians

Keywords

Clinical reasoning

Medical education

Quantitative methods

Situated cognition

Journal Title bmc medical education
Publication Year Start




PMID- 29141616
OWN - NLM
STAT- MEDLINE
DCOM- 20180129
LR  - 20180129
IS  - 1472-6920 (Electronic)
IS  - 1472-6920 (Linking)
VI  - 17
IP  - 1
DP  - 2017 Nov 15
TI  - Contextual factors and clinical reasoning: differences in diagnostic and
      therapeutic reasoning in board certified versus resident physicians.
PG  - 211
LID - 10.1186/s12909-017-1041-x [doi]
AB  - BACKGROUND: The impact of context on the complex process of clinical reasoning is
      not well understood. Using situated cognition as the theoretical framework and
      videos to provide the same contextual "stimulus" to all participants, we examined
      the relationship between specific contextual factors on diagnostic and
      therapeutic reasoning accuracy in board certified internists versus resident
      physicians. METHODS: Each participant viewed three videotaped clinical encounters
      portraying common diagnoses in internal medicine. We explicitly modified the
      context to assess its impact on performance (patient and physician contextual
      factors). Patient contextual factors, including English as a second language and 
      emotional volatility, were portrayed in the videos. Physician participant
      contextual factors were self-rated sleepiness and burnout.. The accuracy of
      diagnostic and therapeutic reasoning was compared with covariates using Fisher
      Exact, Mann-Whitney U tests and Spearman Rho's correlations as appropriate.
      RESULTS: Fifteen board certified internists and 10 resident physicians
      participated from 2013 to 2014. Accuracy of diagnostic and therapeutic reasoning 
      did not differ between groups despite residents reporting significantly higher
      rates of sleepiness (mean rank 20.45 vs 8.03, U = 0.5, p < .001) and burnout
      (mean rank 20.50 vs 8.00, U = 0.0, p < .001). Accuracy of diagnosis and treatment
      were uncorrelated (r = 0.17, p = .65). In both groups, the proportion scoring
      correct responses for treatment was higher than the proportion scoring correct
      responses for diagnosis. CONCLUSIONS: This study underscores that specific
      contextual factors appear to impact clinical reasoning performance. Further, the 
      processes of diagnostic and therapeutic reasoning, although related, may not be
      interchangeable. This raises important questions about the impact that contextual
      factors have on clinical reasoning and provides insight into how clinical
      reasoning processes in more authentic settings may be explained by situated
      cognition theory.
FAU - McBee, Elexis
AU  - McBee E
AUID- ORCID: http://orcid.org/0000-0003-1037-181X
AD  - Department of Medicine, Naval Medical Center San Diego, 34800 Bob Wilson Drive,
      San Diego, 92134, California, USA. [email protected]
FAU - Ratcliffe, Temple
AU  - Ratcliffe T
AD  - Department of Medicine, University of Texas Health Science Center at San Antonio,
      7703 Floyd Curl Drive, San Antonio, 78229, Texas, USA.
FAU - Picho, Katherine
AU  - Picho K
AD  - Department of Medicine, F. Edward Hebert School Of Medicine, Uniformed Services
      University, 4301 Jones Bridge Rd, Bethesda, 20814, Maryland, USA.
FAU - Schuwirth, Lambert
AU  - Schuwirth L
AD  - Flinders University, School of Medicine, GPO Box 2100, Adelaide, 5001, South
      Australia, Australia.
FAU - Artino, Anthony R Jr
AU  - Artino AR Jr
AD  - Department of Medicine, F. Edward Hebert School Of Medicine, Uniformed Services
      University, 4301 Jones Bridge Rd, Bethesda, 20814, Maryland, USA.
FAU - Yepes-Rios, Ana Monica
AU  - Yepes-Rios AM
AD  - Department of Medicine, F. Edward Hebert School Of Medicine, Uniformed Services
      University, 4301 Jones Bridge Rd, Bethesda, 20814, Maryland, USA.
FAU - Masel, Jennifer
AU  - Masel J
AD  - Department of Medicine, Walter Reed National Military Medical Center, 8901
      Wisconsin Ave, Bethesda, 20889, Maryland, USA.
FAU - van der Vleuten, Cees
AU  - van der Vleuten C
AD  - Department of Educational Development and Research, Maastricht University,
      Maastricht, 6200, MD, The Netherlands.
FAU - Durning, Steven J
AU  - Durning SJ
AD  - Department of Medicine, F. Edward Hebert School Of Medicine, Uniformed Services
      University, 4301 Jones Bridge Rd, Bethesda, 20814, Maryland, USA.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
DEP - 20171115
PL  - England
TA  - BMC Med Educ
JT  - BMC medical education
JID - 101088679
RN  - 0 (Acanthopanax gracilistylus, extract)
RN  - 0 (Drugs, Chinese Herbal)
SB  - IM
MH  - Burnout, Professional/*psychology
MH  - Clinical Competence/*standards
MH  - Clinical Decision-Making
MH  - Cognition
MH  - Drugs, Chinese Herbal
MH  - Educational Measurement
MH  - Factor Analysis, Statistical
MH  - Fatigue/*psychology
MH  - Female
MH  - Humans
MH  - Internal Medicine/*education
MH  - Internship and Residency/*standards
MH  - Male
MH  - *Physicians/psychology/standards
MH  - Pilot Projects
MH  - Problem Solving
MH  - Reproducibility of Results
MH  - Video Recording
PMC - PMC5688653
OTO - NOTNLM
OT  - Clinical reasoning
OT  - Medical education
OT  - Quantitative methods
OT  - Situated cognition
EDAT- 2017/11/17 06:00
MHDA- 2018/01/30 06:00
CRDT- 2017/11/17 06:00
PHST- 2016/12/24 00:00 [received]
PHST- 2017/11/02 00:00 [accepted]
PHST- 2017/11/17 06:00 [entrez]
PHST- 2017/11/17 06:00 [pubmed]
PHST- 2018/01/30 06:00 [medline]
AID - 10.1186/s12909-017-1041-x [doi]
AID - 10.1186/s12909-017-1041-x [pii]
PST - epublish
SO  - BMC Med Educ. 2017 Nov 15;17(1):211. doi: 10.1186/s12909-017-1041-x.