Therapeutic reasoning: from hiatus to hypothetical model
Article first published online: 23 DEC 2009
© 2009 The Authors. Journal compilation © 2009 Blackwell Publishing Ltd
Journal of Evaluation in Clinical Practice
Special Issue: Evidence Based Medicine
Volume 15, Issue 6, pages 985–989, December 2009
How to Cite
Bissessur, S. W., Geijteman, E. C. T., Al-Dulaimy, M., Teunissen, Pim. W., Richir, M. C., Arnold, A. E. R. and De Vries, T. P. G. M. (2009), Therapeutic reasoning: from hiatus to hypothetical model. Journal of Evaluation in Clinical Practice, 15: 985–989. doi: 10.1111/j.1365-2753.2009.01136.x
- Issue published online: 23 DEC 2009
- Article first published online: 23 DEC 2009
- Accepted for publication: 28 August 2008
- medical education;
- therapeutic reasoning;
- undergraduate medical education
Rationale Extensive research has been conducted on clinical reasoning to gain better understanding of this process. Clinical reasoning has been defined as the process of thinking critically about the diagnosis and patient management. However, most research has focused on the process of diagnostic reasoning. Because of the lack of understanding regarding therapeutic reasoning, education in patient management decisions lacks a solid theoretical basis.
Aims and objective To improve medical education, training and refresher courses with regard to therapeutic decision making.
Methods A search on the literature about clinical reasoning has been conducted. Based on this literature a hypothetical model of therapeutic reasoning is developed.
Results It is assumed on the literature about diagnostic and therapeutic reasoning that after the diagnosis has been formulated, the process of determining the therapy is initiated by a concept called the therapy script. Patient cases unconsciously elicit such scripts and they consist of relevant treatments, knowledge and clinical experiences. Analytical and non-analytical processes determine the final choice of therapy. Subsequently, these processes adapt the therapy script continuously.
Conclusions A hypothetical model of therapeutic reasoning has been developed in order to improve medical education, training and refresher courses with regard to therapeutic decision making. Future research should empirically test the validity of this hypothetical model in different phases of the medical education continuum.