Examining the Influence of Context and Professional Culture on Clinical Reasoning Through Rhetorical-Narrative Analysis

Abstract

According to the dual process model of reasoning, physicians make diagnostic decisions using two mental systems: System 1, which is rapid, unconscious, and intuitive, and System 2, which is slow, rational, and analytical. Currently, little is known about physicians' use of System 1 or intuitive reasoning in practice. In a qualitative study of clinical reasoning, physicians were asked to tell stories about times when they used intuitive reasoning while working up an acutely unwell patient, and we combine socio-narratology and rhetorical theory to analyze physicians' stories. Our analysis reveals that in describing their work, physicians draw on two competing narrative structures: one that is aligned with an evidence-based medicine approach valuing System 2 and one that is aligned with cooperative decision making involving others in the clinical environment valuing System 1. Our findings support an understanding of clinical reasoning as distributed, contextual, and influenced by professional culture.

Eyeballing: the use of visual appearance to diagnose ‘sick’

“…Clinicians readily describe this skill as an important component of their expertise, requiring years of experience to develop the ability to make a snap judgement, ‘thin‐slice’ or ‘blink’ decision about a patient's illness severity based on visual appearance alone. Experienced clinicians describe intuitively recognising ‘sick’ as an immediate impression formed from a patient's appearance, even when vital signs are within normal range .…”

Developing a framework for teaching clinical reasoning skills to undergraduate physiotherapy students: A Delphi study

“…Pattern recognition and professional intuition are most likely "fast" thinking processes. Professional or clinical intuition has been described as a "feeling" and may also overlap with "clinical gut feeling" (Langridge, Roberts, & Pope, 2016;Peters et al, 2017;Van den Bruel, Thompson, Buntinx, & Mant, 2012). Hypothetico-deductive reasoning is a "slow" thinking processes, being analytical, conscious and conceptual (Peters et al, 2017).…”

“…Professional or clinical intuition has been described as a "feeling" and may also overlap with "clinical gut feeling" (Langridge, Roberts, & Pope, 2016;Peters et al, 2017;Van den Bruel, Thompson, Buntinx, & Mant, 2012). Hypothetico-deductive reasoning is a "slow" thinking processes, being analytical, conscious and conceptual (Peters et al, 2017). This reasoning process generates hypotheses at multiple levels from the first patient encounter, and then moves towards assessment of the patient's problem and diagnosis, establishes goals and planning, and provision of interventions (Levett-Jones et al, 2010).…”

“…Besides exposure to clinical practice, development of teaching resources applicable across laboratory and clinical teaching are required. For example, strategies such as case-based learning and continuous reflection facilitate the development of "fast" thinking (Carvalho et al, 2017;Peters et al, 2017). Clear communication and collaboration across all educators (lecture-, laboratory-and clinical-based teaching) in terms of approaches to teaching such skills will facilitate student acquisition of clinical reasoning skills in various contexts.…”

Professional Culture And Attitude To Personality Security In Future Specialists

“…Examining professional culture of a specialist, researchers focus on its relationship with personality traits (Rosenthal, Tsao, Tsuyuki, & Marra, 2016) and professional features of mentality of https://doi.org/10.15405/epsbs.2019.12.83 Corresponding Author: Anna Zakharova Selection and peer-review under responsibility of the Organizing Committee of the conference eISSN: 2357-1330 787 specialists (Peters et al, 2017). They analyze the essence, structure and mission of professional culture of a modern specialist.…”