Reasoning processes in clinical reasoning: from the perspective of cognitive psychology
1
조회
0
다운로드
2
인용
0
참고문헌
키워드
초록
Clinical reasoning is considered a crucial concept in reaching medical decisions. This paper reviews the reasoning processes involved in clinical reasoning from the perspective of cognitive psychology. To properly use clinical reasoning, one requires not only domain knowledge but also structural knowledge, such as critical thinking skills. In this paper, two types of reasoning process required for critical thinking are discussed: inductive and deductive. Inductive and deductive reasoning processes have different features and are generally appropriate for different types of tasks. Numerous studies have suggested that experts tend to use inductive reasoning while novices tend to use deductive reasoning. However, even experts sometimes use deductive reasoning when facing challenging and unfamiliar problems. In clinical reasoning, expert physicians generally use inductive reasoning with a holistic viewpoint based on a full understanding of content knowledge in most cases. Such a problem-solving process appears as a type of recognition-primed decision making only in experienced physicians’ clinical reasoning. However, they also use deductive reasoning when distinct patterns of illness are not recognized. Therefore, medical schools should pursue problem-based learning by providing students with various opportunities to develop the critical thinking skills required for problem solving in a holistic manner.
Abstract
Clinical reasoning is considered a crucial concept in reaching medical decisions. This paper reviews the reasoning processes involved in clinical reasoning from the perspective of cognitive psychology. To properly use clinical reasoning, one requires not only domain knowledge but also structural knowledge, such as critical thinking skills. In this paper, two types of reasoning process required for critical thinking are discussed: inductive and deductive. Inductive and deductive reasoning processes have different features and are generally appropriate for different types of tasks. Numerous studies have suggested that experts tend to use inductive reasoning while novices tend to use deductive reasoning. However, even experts sometimes use deductive reasoning when facing challenging and unfamiliar problems. In clinical reasoning, expert physicians generally use inductive reasoning with a holistic viewpoint based on a full understanding of content knowledge in most cases. Such a problem-solving process appears as a type of recognition-primed decision making only in experienced physicians’ clinical reasoning. However, they also use deductive reasoning when distinct patterns of illness are not recognized. Therefore, medical schools should pursue problem-based learning by providing students with various opportunities to develop the critical thinking skills required for problem solving in a holistic manner.
참고문헌 (47)
- Norman G, "Research in clinical reasoning : past history and current trends", Med Educ, 39(4), pp.418~427 (2005)
- Cutrer WB, "Educational strategies for improving clinical reasoning", Curr Probl Pediatr Adolesc Health Care, 43(9), pp.248~257 (2013)
- Eva KW, "What every teacher needs to know about clinical reasoning", Med Educ, 39(1), pp.98~106 (2005)
- Higgs J, "Clinical Reasoning in the Health Professions", pp.3~17 (2008), Butterworth-Heineman Ltd
- Fernando I, "A systematic approach to clinical reasoning in psychiatry", Australas Psychiatry, 21(3), pp.224~230 (2013)
- Edwards I, "Clinical reasoning strategies in physical therapy", Phys Ther, 84(4), pp.312~335 (2004)
- Jonassen DH, "Toward a design theory of problem solving", Educ Technol Res Dev, 48(4), pp.63~85 (2000)
- Jonassen D, "An outcomes-based taxonomy for the design, evaluation, and research of instructional systems", Train Res J, 2(1996), pp.97~ (1996)
- Rumelhart DE, "Schooling and the Acquisition of Knowledge", pp.99~135 (1976), Lawrence Erlbaum Associates Inc
- Jonassen DH, "Learning to solve problems: a handbook for designing problem-solving learning environments" (2011), Routledge
- Jonassen DH, "Learning to troubleshoot : a new theory-based design architecture", Educ Psychol Rev, 18(1), pp.77~114 (2006)
- Jonassen DH, "Designing effective supports for causal reasoning", Educ Technol Res Dev, 56(3), pp.287~308 (2008)
- Noordman LG, "Memory‐based processing in understanding causal information", Discourse Process, 26(2-3), pp.191~212 (1998)
- Richmond B, "Systems thinking : critical thinking skills for the 1990s and beyond", Syst Dyn Rev, 9(2), pp.113~133 (1993)
- Rubenstein-Montano B, "A systems thinking framework for knowledge management", Decis Support Syst, 31(1), pp.5~16 (2001)
- Mingers J, "Problem structuring methods in action", Eur J Oper Res, 152(3), pp.530~554 (2004)
- Anderson JR, "Cognitive psychology and its implications" (1980), W. H. Freeman and Company
- Jacobs AE, "Validation of a short questionnaire to assess the degree of complexity and structuredness of PBL problems", Med Educ, 37(11), pp.1001~1007 (2003)
- Fischer R, "Public relations problem solving : heuristics and expertise", J Public Relat Res, 10(2), pp.137~153 (1998)
- Johnson-Laird PN, "Mental models and probabilistic thinking", Cognition, 50(1-3), pp.189~209 (1994)
- Anderson JR, "Problem solving and learning", Am Psychol, 48(1), pp.35~ (1993)
- Newell A, "Human problem solving" (1972), Prentice-Hall
- Sweller J, "Cognitive load during problem solving: effects on learning", Cogn Sci, 12(2), pp.257~285 (1988)
- Scavarda AJ, "A methodology for constructing collective causal maps", Decis Sci, 37(2), pp.263~283 (2006)
- Overmars KP, "Comparison of a deductive and an inductive approach to specify land suitability in a spatially explicit land use model", Land Use Policy, 24(3), pp.584~599 (2007)
- Sharma T, "Study of difference between forward and backward reasoning", Int J Emerg Technol Adv Eng, 2(10), pp.271~273 (2012)
- Monsen KA, "Data management for intervention effectiveness research : comparing deductive and inductive approaches", Res Nurs Health, 32(6), pp.647~656 (2009)
- "Forward chaining vs. backward chaining"[URL]
- Scavarda AJ, "A review of the causal mapping practice and research literature", Paper presented at: Second World Conference on POM and 15th Annual POM Conference (2004)
- Eseryel D, "Validation study of a method for assessing complex ill-structured problem solving by using causal representations", Educ Technol Res Dev, 61(3), pp.443~463 (2013)
- Hong L, "The influence of complexity and reasoning direction on children’s causal reasoning", Cogn Dev, 20(1), pp.87~101 (2005)
- Sweller J, "Teaching general problem solving does not lead to mathematical skills or knowledge", EMS Newsl, 41~42 (2011)
- Frensch PA, "Complex Problem Solving: The European Perspective", pp.3~26 (1995), Lawrence Erlbaum Associates Inc
- Smith MU, "Toward a unified theory of problem solving: views from the content domains" (2012), Routledge
- Larkin J, "Expert and novice performance in solving physics problems", Science, 208(4450), pp.1335~1342 (1980)
- Coderre S, "Diagnostic reasoning strategies and diagnostic success", Med Educ, 37(8), pp.695~703 (2003)
- Kyriacou DN, "Evidence-based medical decision making : deductive versus inductive logical thinking", Acad Emerg Med, 11(6), pp.670~671 (2004)
- Harasym PH, "Current trends in developing medical students’ critical thinking abilities", Kaohsiung J Med Sci, 24(7), pp.341~355 (2008)
- Vertue FM, "An abductive perspective on clinical reasoning and case formulation", J Clin Psychol, 64(9), pp.1046~1068 (2008)
- Tavakol M, "Quantitative and qualitative methods in medical education research : AMEE guide no 90 : part I", Med Teach, 36(9), pp.746~756 (2014)
- Klein GA, "A recognition-primed decision (RPD) model of rapid decision making" (1993), Ablex Publishing Corp
- Klein G, "Developing expertise in decision making", Think Reason, 3(4), pp.337~352 (1997)
- Croskerry P, "Clinical cognition and diagnostic error:applications of a dual process model of reasoning", Adv Health Sci Educ Theory Pract, 14(Suppl 1), pp.27~35 (2009)
- Croskerry P, "A universal model of diagnostic reasoning", Acad Med, 84(8), pp.1022~1028 (2009)
- Croskerry P, "Context is everything or how could I have been that stupid", Healthc Q, 12(Suppl), pp.e171~e177 (2009)
- May S, "Limited clinical reasoning skills used by novice physiotherapists when involved in the assessment and management of patients with shoulder problems : a qualitative study", J Man Manip Ther, 18(2), pp.84~88 (2010)
- Pinnock R, "Learning clinical reasoning", J Paediatr Child Health, 50(4), pp.253~257 (2014)
