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Clinical reasoning of junior doctors in emergency medicine: a grounded theory study
journal contribution
posted on 2017-02-01, 00:00 authored by E Adams, C Goyder, C Heneghan, L Brand, Rola AjjawiRola AjjawiINTRODUCTION: Emergency medicine (EM) has a high case turnover and acuity making it a demanding clinical reasoning domain especially for junior doctors who lack experience. We aimed to better understand their clinical reasoning using dual cognition as a guiding theory. METHODS: EM junior doctors were recruited from six hospitals in the south of England to participate in semi-structured interviews (n=20) and focus groups (n=17) based on recall of two recent cases. Transcripts were analysed using a grounded theory approach to identify themes and to develop a model of junior doctors' clinical reasoning in EM. RESULTS: Within cases, clinical reasoning occurred in three phases. In phase 1 (case framing), initial case cues and first impressions were predominantly intuitive, but checked by analytical thought and determined the urgency of clinical assessment. In phase 2 (evolving reasoning), non-analytical single cue and pattern recognitions were common which were subsequently validated by specific analytical strategies such as use of red flags. In phase 3 (ongoing uncertainty) analytical self-monitoring and reassurance strategies were used to precipitate a decision regarding discharge. CONCLUSION: We found a constant dialectic between intuitive and analytical cognition throughout the reasoning process. Our model of clinical reasoning by EM junior doctors illustrates the specific contextual manifestations of the dual cognition theory. Distinct diagnostic strategies are identified and together these give EM learners and educators a framework and vocabulary for discussion and learning about clinical reasoning.
History
Journal
Emergency medicine journalVolume
34Issue
2Pagination
70 - 75Publisher
BMJ Publishing GroupLocation
London, Eng.Publisher DOI
eISSN
1472-0213Language
engPublication classification
C1 Refereed article in a scholarly journalCopyright notice
2016, BMJ Publishing Group LimitedUsage metrics
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No categories selectedKeywords
clinical assessment, educationeducation, teachingemergency departmentsteachingtrainingAdultDecision MakingEmergency MedicineEnglandFemaleFocus GroupsGrounded TheoryHumansInternship and ResidencyInterviews as TopicMaleMedical Staff, HospitalThinkingScience & TechnologyLife Sciences & BiomedicinePRIMARY-CAREEDUCATIONSTRATEGIESCOGNITIONMODEL
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