What is CLINICAL REASONING?

Question 1

What is CLINICAL REASONING?

Answer 1

“An inferential process used by practitioners to collect and evaluate data and to make judgments about the diagnosis and management of patient problems”
(Edwards et al. 2004)

Question 1

Part of clinical reasoning is also “__”

Answer 1

prognosis

Question 2

“Clinical Reasoning*** –

Answer 2

the sum of the thinking and decision-making processes associated with clinical practice

Question 3

Collect and analyze ___ variables

Answer 3

multiple

Question 4

Determine ___ limitations (the ability to execute a task or action in a standard environment) and ___ deficits (what the patient can do in his or her own current ___).

Answer 4

capacity
performance
environment

Question 5

Generate ___ to explain these factors that includes identifying the impact on the patient’s life

Answer 5

hypotheses

Question 6

Interacts with the patient and ___ (family, other health care professionals)

Answer 6

others involved

Question 7

Find ___ goals and health management strategies

Answer 7

meaningful

Question 8

Decisions and actions are in line with professional ___ and community ___

Answer 8

ethics
expectations

Question 9

Core dimensions:

Answer 9

Knowledge
Cognition
Metacognition

Question 10

Knowledge =

Answer 10

derived from theory and research, professional and personal experience

Question 11

Cognition =

Answer 11

also called: reflective inquiry

analysis, synthesis and evaluation of data collected

Question 12

Metacognition =

Answer 12

bridge knowledge and cognition

identify limitations in the quality of information, monitoring their reasoning and practice

seeking errors and credibility

Question 13

Additional dimensions:

Answer 13

Mutual decision-making

Contextual interaction

Task impact

Question 14

No single model of clinical reasoning because:

Answer 14

> Complex nature of clinical reasoning

> Context dependent nature

> Individuality of expertise

> Changing conceptions of quality and error

> Challenge to novices in developing clinical reasoning skills and to educators in facilitating this development

Question 15

Clinical reasoning is an invisible ___ but linked with more visible ___ (e.g. making diagnosis, interventions, case conference)

Answer 15

process

behaviors

Question 16

Clinical reasoning is ___

Answer 16

developmental

Question 17

Clinical reasoning can be implemented as a ___ practitioner process or a ___ process

Answer 17

sole
group

Question 18

Clinical reasoning is grounded on ____

Answer 18

evidence-based practice and public accountability

Question 19

____ are required

Answer 19

Language and interactive behaviors

Question 20

Clinical reasoning requires a range of capabilities such as ____

Answer 20

emotional and social

Question 21

Clinical reasoning is ____

Answer 21

quality assurance or quality improvement

Question 22

“These 3 things”

Answer 22

Clinical reasoning is a complex process

Clinical reasoning is making sense of data

Clinical reasoning takes practice

Question 23

(ICF)

Answer 23

International Classification of Functioning, Disability, and Health

Question 24

Examination =

Answer 24

History
Systems review
Specific tests and measures

Question 25

Evaluation leading to

Answer 25

Diagnosis
Prognosis

Question 26

Intervention =

Answer 26

Intervention

Question 27

Outcomes =

Answer 27

Measurement of Individual versus group outcomes

Question 28

Is This My Patient?

What types of questions must you ask before determining your relationship to this person?

Answer 28

Legal
Ethical
Practitioner competence
Practitioner status

Question 29

Legal Q’s=

Answer 29

Can I legally provide services of a first aid nature to this person?

Can I legally provide services of a physical therapy nature to this person? In this setting?

Is there a Good Samaritan law in this jurisdiction that will protect me if my actions cause harm? Does such a law protect me as a citizen, as well as a health care provider?

Question 30

Ethical Q’s =

Answer 30

Am I obliged by my code of ethics to provide first aid services to this person?

Can I refuse to help this person?

Must I seek the person’s permission before giving advice or direct care?

Question 31

Practitioner Competence Q’s =

Answer 31

Am I a qualified first aid provider?

Am I skilled at diagnosing injuries of the ankle?

If I initiate an evaluation of this person, will I know what to do with the information I gather?

Question 32

Practitioner Status Q’s=

Answer 32

Am I impaired in any way at this point in the day based upon what I have done or ingested?

Am I reluctant to become involved to the extent that my judgment might be impaired?

Question 33

Importance of Early Decisions

Answer 33

Take time to think broadly about the implications of early decisions, envisioning the long-term outcomes.

Decisions about Who to Treat, and When to Treat are reported as some of the most difficult decisions to make in practice.

Question 34

What types of diagnostic reasoning will be most helpful?

Answer 34

Legal
Ethical
Diagnostic
Prognostic
Intervention

Question 35

Legal diagnostic reasoning =

Answer 35

1. Get the patient’s verbal consent for your examination.

Question 36

Ethical diagnostic reasoning =

Answer 36

1. Determine what will maximize patient comfort first.
2. Determine what actions would make the injury worse and avoid these.

Question 37

Diagnostic diagnostic reasoning =

Answer 37

Determine how to perform your examination.

Determine the extent of the injury to the ankle and surrounding tissues.

Assess your confidence in your diagnosis.

Question 38

Prognostic diagnostic reasoning =

Answer 38

Determine the need for additional medical attention immediately or within the next 24 hours.

Question 39

Intervention diagnostic reasoning =

Answer 39

Select immediate necessary care and implement.

Identify follow-up care and make recommendations.

Perform the interventions or delegate them to the patient and family.

Seek treatment supplies or delegate this to the patient and family.

Question 40

Types of Diagnostic Reasoning

Answer 40

Hypothetico-Deductive Reasoning (or backward reasoning)

Pattern Recognition Reasoning (or forward reasoning)

Question 41

Hypothetico-Deductive Reasoning (or backward reasoning) =

Answer 41

Gather clues

Formulate the hypothesis

Test the hypothesis (e.g. re-evaluation, return visits)

Helpful in simple scenarios

Question 42

Pattern Recognition Reasoning (or forward reasoning) =

Answer 42

Used by experienced clinicians with well-organized knowledge base

Depends upon well-recognized combinations of symptoms, called patterns

Helpful in complex scenarios

Basic science + practical knowledge + reflexive practice

Question 43

Physical therapist are not concerned with a correct diagnosis of pathology as they are with a ____

Answer 43

correct understanding and labeling of significant impairments and functional limitations of the patient.