Deliberate reflection and clinical reasoning: Founding ideas and empirical findings.
Context: The idea that reflection improves reasoning and learning, since long present in other fields, emerged in the 90s in the medical education literature. Since then, the number of publications on reflection as a means to improve diagnostic learning and clinical problem‐solving has increased ste...
| Publicado en: | Medical Education Vol. 57; no. 1; pp. 76 - 86 |
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| Autores principales: | , |
| Formato: | case study tables/charts Journal Article |
| Publicado: |
Wiley-Blackwell
Jan2023
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=160717512&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 160717512 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 03080110 ESF jtl: Medical Education issn: 03080110 maglogo: Y pubinfo: dt: Jan2023 vid: 57 iid: 1 pid: 480 pub: Wiley-Blackwell place: Malden, Massachusetts artinfo: ui: 160717512 158028558 160717512 160717512 10.1111/medu.14863 160717512 ppf: 76 ppct: 10 formats: fmt: – @attributes: type: T – @attributes: type: P tig: atl: Deliberate reflection and clinical reasoning: Founding ideas and empirical findings. aug: au: Mamede, Sílvia Schmidt, Henk G. affil: Institute of Medical Education Research Rotterdam, Erasmus MC sug: subj: Reflection Diagnostic Reasoning Learning Philosophy Theory Treatment Errors Physicians Job Performance Students Male Middle Age Physical Examination Diagnostic Tests, Routine Cough Dyspnea Thorax Pathology Diagnosis, Differential Middle Aged: 45-64 years Male ab: Context: The idea that reflection improves reasoning and learning, since long present in other fields, emerged in the 90s in the medical education literature. Since then, the number of publications on reflection as a means to improve diagnostic learning and clinical problem‐solving has increased steeply. Recently, concerns with diagnostic errors have raised further interest in reflection. Several approaches based on reflection have been proposed to reduce clinicians' errors during diagnostic reasoning. What reflection entails varies substantially, and most approaches still require empirical examination. Purpose The present essay aims to help clarify the role of deliberate reflection in diagnostic reasoning. Deliberate reflection is an approach whose effects on diagnostic reasoning and learning have been empirically studied over the past 15 years. The philosophical roots of the approach will be briefly examined, and the theory and practice of deliberate reflection, particularly its effectiveness, will be reviewed. Lessons learned and unresolved issues will be discussed. Discussion The deliberate reflection approach originated from a conceptualization of the nature of reflection practice in medicine informed by Dewey's and Schön's work. The approach guides physicians through systematically reviewing the grounds of their initial diagnosis and considering alternatives. Experimental evidence has supported the effectiveness of deliberate reflection in increasing physicians' diagnostic performance, particularly in nonstraightforward diagnostic tasks. Deliberate reflection has also proved helpful to improve students' diagnostic learning and to facilitate learning of new information. The mechanisms behind the effects of deliberate reflection remain unclear. Tentative explanations focus on the activation/reorganisation of prior knowledge induced by deliberate reflection. Its usefulness depends therefore on the difficulty of the problem relative to the clinician's knowledge. Further research should examine variations in instructions on how to reflect upon a case, the value of further guidance while learning from deliberate reflection, and its benefits in real practice. The authors summarize the lessons learned from research on deliberate reflection, synthesizing its theory and practice, its effects on diagnostic performance and unresolved issues that demand further research. pubtype: Academic Journal doctype: case study tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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