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Clinical reasoning processes: unravelling complexity through graphical representation

Authors

  • Bernard Charlin,

    1. Centre for Applied Pedagogy in Health Sciences (Centre de Pédagogie Appliquée aux Sciences de la Santé [CPASS]), University of Montreal, Montreal, Quebec, Canada
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  • Stuart Lubarsky,

    1. Centre for Medical Education, McGill University, Montreal, Quebec, Canada
    2. Department of Neurology, Montreal General Hospital, Montreal, Quebec, Canada
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  • Bernard Millette,

    1. Centre for Applied Pedagogy in Health Sciences (Centre de Pédagogie Appliquée aux Sciences de la Santé [CPASS]), University of Montreal, Montreal, Quebec, Canada
    2. Department of Family and Emergency Medicine, Hôpital Cité de la Santé de Laval, Quebec, Canada
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  • Françoise Crevier,

    1. Consultant, Educational Engineering, Faculty of Pharmacy, University of Montreal, Montreal, Quebec, Canada
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  • Marie-Claude Audétat,

    1. Centre for Applied Pedagogy in Health Sciences (Centre de Pédagogie Appliquée aux Sciences de la Santé [CPASS]), University of Montreal, Montreal, Quebec, Canada
    2. Department of Family and Emergency Medicine, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada
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  • Anne Charbonneau,

    1. Department of Oral Health, Faculty of Dental Medicine, University of Montreal, Montreal, Quebec, Canada
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  • Nathalie Caire Fon,

    1. Centre for Applied Pedagogy in Health Sciences (Centre de Pédagogie Appliquée aux Sciences de la Santé [CPASS]), University of Montreal, Montreal, Quebec, Canada
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  • Lea Hoff,

    1. Department of Medicine, CPASS, University of Montreal, Montreal, Quebec, Canada
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  • Christian Bourdy

    1. Department of Family and Emergency Medicine, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada
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Professor Bernard Charlin, Médecine Direction, Centre de Pédagogie Appliquée aux Sciences de la Santé (CPASS), Université de Montréal, CP 6128, succ. Centre-Ville, Montreal, Quebec H3C 3J7, Canada. Tel: 00 1 514 343 7864; Fax: 00 1 514 343 7650; E-mail: bernard.charlin@umontreal.ca

Abstract

Medical Education 2012: 46: 454–463

Context  Clinical reasoning is a core skill in medical practice, but remains notoriously difficult for students to grasp and teachers to nurture. To date, an accepted model that adequately captures the complexity of clinical reasoning processes does not exist. Knowledge-modelling software such as mot Plus (Modelling using Typified Objects [MOT]) may be exploited to generate models capable of unravelling some of this complexity.

Objectives  This study was designed to create a comprehensive generic model of clinical reasoning processes that is intended for use by teachers and learners, and to provide data on the validity of the model.

METHODS  Using a participatory action research method and the established modelling software (mot Plus), knowledge was extracted and entered into the model by a cognitician in a series of encounters with a group of experienced clinicians over more than 250 contact hours. The model was then refined through an iterative validation process involving the same group of doctors, after which other groups of clinicians were asked to solve a clinical problem involving simulated patients.

Results  A hierarchical model depicting the multifaceted processes of clinical reasoning was produced. Validation rounds suggested generalisability across disciplines and situations.

Conclusions  The MOT model of clinical reasoning processes has potentially important applications for use within undergraduate and graduate medical curricula to inform teaching, learning and assessment. Specifically, it could be used to support curricular development because it can help to identify opportune moments for learning specific elements of clinical reasoning. It could also be used to precisely identify and remediate reasoning errors in students, residents and practising doctors with persistent difficulties in clinical reasoning.

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