Clinical Reasoning and Case-Based Decision Making: The Fundamental Challenge to Veterinary Educators

Abstract

Confusion about the nature of human reasoning and its appropriate application to patients has hampered veterinary students' development of these skills. Expertise is associated with greater ability to deploy pattern recognition (type 1 reasoning), which is aided by progressive development of data-driven, forward reasoning (in contrast to scientific, backward reasoning), analytical approaches that lead to schema acquisition. The associative nature of type 1 reasoning makes it prone to bias, particularly in the face of “cognitive miserliness,” when clues that indicate the need for triangulation with an analytical approach are ignored. However, combined reasoning approaches, from the earliest stages, are more successful than one approach alone, so it is important that those involved in curricular design and delivery promote student understanding of reasoning generally, and the situations in which reasoning goes awry, and develop students' ability to reason safely and accurately whether presented with a familiar case or with a case that they have never seen before.

Accuracy of intuition in clinical decision‐making among novice clinicians

“…medicine, dentistry, veterinary) encourage students to make use of pattern recognition skill, which is a dominant feature of intuition (Mamede et al 2010, Lighthall & Vazquez-Guillamet 2015. These educators assert that students be given learning opportunities that emphasize both the intuitive and analytical approaches to clinical reasoning, including those that specifically require a holistic and contextualized response (Laurillard 2013, May 2013. Specifically teaching the pattern recognition component of intuition has been shown to enhance CDM among nursing and medical students (Pelaccia et al 2009).…”

Students' Perceptions of the Script Concordance Test and Its Impact on Their Learning Behavior: A Mixed Methods Study

“…While exposure to patients is essential to develop these skills, it is insufficient on its own. 19 The perceived benefits of the SCT by many students support the development of this formative assessment to facilitate the development of clinical reasoning within veterinary curricula. With increasing student numbers, universities are faced with challenges to maintain effective delivery of WPBL.…”

“…[9][10][11][12][13][14][15][16][17][18] Several theories have been proposed to explain the cognitive processes involved in clinical reasoning and decision making. 19 Script theory is one such example. It describes the way clinicians store and utilize their knowledge when faced with clinical cases.…”

Scaffolded Active Learning: Nine Pedagogical Principles for Building a Modern Veterinary Curriculum

“…The intention is that the interest stimulated by context-related problem solving, and the associated active learning, will build on framework knowledge to allow personal and integrated knowledge construction in a way that is similar to but more efficient than PBL. Together with instruction in scientific and clinical reasoning, it is intended that case-based directed learning will promote effective problem solving, which can then be further developed through clinical skills classes and in the clinics themselves as "integrated knowledge" that supports rational judgments and actions (May, 2013).…”