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Clinical reasoning
Published in Caroline J Rodgers, Richard Harrington, Helping Hands: An Introduction to Diagnostic Strategy and Clinical Reasoning, 2019
Caroline J Rodgers, Richard Harrington
In terms of models of clinical decision making, the most widely accepted is the dual process theory. It is generally accepted (with support from functional MRI studies) that, in making a diagnosis, medical students and expert clinicians use both analytic and non-analytic reasoning (the two cognitive processes that have been demonstrated to be both physiologically and anatomically distinct).10–12 Use of a combination has been shown to have improved accuracy over a single approach.13 This combined approach is known as ‘dual process theory’; in this an intuitive (system 1) response (often using visual information and sometimes referred to as ‘non-analytic reasoning’) is combined with a rational and deliberative response (system 2 – analytic reasoning).9 Qualitative studies exploring how clinicians make decisions have been carried out using dual process theory as a framework.5
The logic in modern medicine: Reasoning and underlying concepts
Published in Milos Jenicek, Foundations of Evidence-Based Medicine, 2019
There are several ways to explain and defend our views and positions. We can do so in (1) a structured way or (2) an implicit, rapid and unconscious way. This dual process theory is increasingly studied and used in philosophy95–98 and in health sciences as well.
Stone Age Minds in Modern Medicine: Ancient Footprints Everywhere
Published in Pat Croskerry, Karen S. Cosby, Mark L. Graber, Hardeep Singh, Diagnosis, 2017
In evolutionary psychology, error management theory (EMT) proposes that such “thinking failures” evident in modern environments are the result of evolved, naturally selected patterns of behavior that served us well in our evolutionary past and for which we are now hardwired [8]. Dual process theory, in turn, proposes that many of these failures are examples of cognitive biases and heuristics, and that these occur largely in the intuitive mode.
Using an experiential learning model to teach clinical reasoning theory and cognitive bias: an evaluation of a first-year medical student curriculum
Published in Medical Education Online, 2023
Justin J. Choi, Jeanie Gribben, Myriam Lin, Erika L. Abramson, Juliet Aizer
However, it remains uncertain whether clinical reasoning theories and cognitive biases can be effectively taught to pre-clerkship medical students given their relatively limited clinical knowledge and lack of clinical experience [12–15]. Medical education based on clinical reasoning theories and cognitive biases has mostly targeted learners with clinical experience [13,14,16–24]. Teaching of clinical reasoning theories has focused on dual process theory and script theory, and some studies have demonstrated improved diagnostic performance among senior medical students and residents [25–31]. Dual process theory is a model of problem solving that posits two systems of thinking: an intuitive and automatic processing that uses heuristics and pattern recognition (System 1), and a more analytic and deliberate processing (System 2)[32,33]. Script theory describes the reorganization of encapsulated knowledge of diseases, conditions, or syndromes into illness scripts, which are cognitive models of disease states that include the predisposing conditions, pathophysiological insults, and clinical consequences [34–37]. In diagnostic clinical reasoning, these theories are manifested in teaching learners how to: (i) formulate a problem representation (i.e., a succinct, abstract summary of the most defining features of the case); (ii) use semantic qualifiers (i.e., opposing descriptors of clinical features that help distinguish between diagnostic considerations); and (iii) search and select for illness scripts that most closely match their representation of a case[38].
Types of clinical reasoning in a summative clerkship oral examination
Published in Medical Teacher, 2022
Vamana Rajeswaran, Luke Devine, Edmund Lorens, Sumitra Robertson, Ella Huszti, Daniel M. Panisko
The dual-process theory has emerged as a commonly used framework to describe clinical reasoning processes. It is derived from cognitive psychology literature and suggests that clinicians use Type 1 and Type 2 (also termed System 1 and System 2) thinking processes when employing clinical reasoning (Kahneman 2003; Croskerry 2009a; Evans and Stanovich 2013; Evans 2019). Type 1 processes involve more intuition, pattern-based and experience-based recognition. Type 2 processes are more cognitively effortful systematic processes, analyzing the data available from the patient encounter. The mental heuristics of Type 1 clinical reasoning have been associated with cognitive biases, whereas Type 2 clinical reasoning is cognitively resource-intensive and less time-efficient (Eva et al. 2007; Croskerry 2009b; Elstein 2009; Croskerry 2013). Cognitive biases and/or knowledge deficits may contribute towards diagnostic error (Norman et al. 2017), however, clinicians use both Type 1 and Type 2 processes synergistically in an attempt to mitigate these errors (Elstein and Schwarz 2002; Croskerry 2009a; Durning et al. 2015).
Inducing System-1-type diagnostic reasoning in second-year medical students within 15 minutes
Published in Medical Teacher, 2018
Lucy Victoria Rosby, Jerome I. Rotgans, Gerald Tan, Naomi Low-Beer, Silvia Mamede, Laura Zwaan, Henk Schmidt
Dual-process theory is one of the theories explaining how doctors make decisions about diagnoses (Croskerry 2009). This theory proposes two constituent types of thinking: System-1 and System-2. System-1 is fast, intuitive, automatic, and requires minimal effort (Evans 2008) allowing clinicians to make diagnoses based on stored “illness scripts” or exemplars and pattern recognition (Charlin et al. 2007) whereas System-2 is slow, deliberate, conceptual, and systematic (Evans 2008). Some consider System-1 reasoning as the hallmark of expertise because it is dependent on the extensive knowledge and experience of the clinician allowing for fast, automatic decision making (Norman et al. 2014), whereas others warn that System-1 may be error-prone (Mamede et al. 2007) and that System-2 must lead to greater diagnostic accuracy due its analytical nature (Croskerry 2003; Kahneman 2011). Research into this area has become more significant in recent years, as diagnostic error has become an issue of great concern amongst patients and doctors (Graber 2013) and has also become an increasingly common reason for malpractice claims all over the world (Walshe et al. 2004; Saber Tehrani et al. 2013).