Clinical Reasoning

The research capacity and output of the clinical reasoning research programme have focused on the two following areas.

The nature of clinical reasoning and prevention of cognitive errors

Medical errors and their adverse effects on patient safety have raised increasing concerns, and particular attention has been drawn to diagnostic mistakes, which often have serious consequences. The majority of diagnostic errors derive from faulty clinical reasoning rather than knowledge gaps. Treatment errors have been less studied but there is evidence that faulty reasoning may also underlie suboptimal physicians’ decisions for the management of patients’ problems. The sources of these flaws in clinical reasoning and how they can be minimized remain to be understood.
This research area explores the nature of clinical reasoning, the sources of reasoning flaws and cognitive errors and how they could be minimized. By using mainly an experimental approach, the research group has conducted studies on the effect of different reasoning modes on diagnostic performance.
This research has shown that deliberate reflection upon a to-be-diagnosed case improves diagnoses, especially when cases are complex. It has provided empirical support to the notion that a good diagnostic performance requires physicians to optimally combine non-analytical and reflective reasoning. Factors that hinder reflection and lead to errors have also been investigated and well as the role of cognitive bias in diagnostic errors. Research within this area will further investigate these issues. Studies will be conducted with medical students, residents and physicians aimed at investigating particularly:

1.  the effects of different reasoning modes on diagnostic performance in different circumstances;
2. different types of factors – related to the context, to the physician or to the problems – that may lead to excessive reliance on non-analytical diagnostic reasoning and, therefore, to errors;
3. the role of different types of cognitive biases in diagnostic and treatment errors;
4. the role of reflective reasoning in counteracting mistakes and how it can be maximized.

Teaching clinical reasoning

Medical education places great emphasis on developing students’ and residents’ clinical competence, but little empirical evidence exists on how clinical teaching should be organized to better achieve this goal. Filling this gap requires studies drawn upon research on medical expertise development to design and test innovative, theory-based teaching/learning approaches.
This research area builds upon research on medical expertise development to investigate better approaches for teaching the clinical sciences. Research on how medical students turn into experts has shown that the way in which knowledge about diseases is organized in mind changes throughout undergraduate education. Becoming able to solve clinical problems depends on acquiring a large knowledge base of scripts of diseases (i.e., illness scripts). To foster the development of such mental representations, it is known that students should not only be exposed to didactic activities but might extensively and repeatedly practice with a variety of clinical problems. Much is to be known, however, about how teaching around clinical problems might be structured so that it is more effective in fostering learning.

Within this research area, experimental studies with advanced medical students have explored the use of structured reflection as an instructional approach to guide students’ practice with patients’ problems. The use of self-explanation while practicing with diagnosing clinical cases has also been investigated. These instructional approaches have shown to foster students’ diagnostic competence relative to other, more conventional, methods. Research within this area will continue to investigate better approaches for teaching clinical reasoning by conducting studies with medical students and residents to exploring:

1. the use of different types of examples and modelling to teach clinical diagnosis;
2. the effects of different types of practice problems, formats and scheduling of practice on development of diagnostic competence;
3. the use of different forms of structured reflection while practicing with clinical cases as an instructional approach to foster the development of clinical reasoning;
4. the use of different forms of self-explanation while practicing with clinical cases as an instructional approach to foster the development of clinical reasoning.