Thierry Pelaccia1, Laurie H Plotnick2, Marie-Claude Audétat3, Mathieu Nendaz4, Stuart Lubarsky5, Nazi Torabi6, Aliki Thomas7, Meredith Young8, Valérie Dory9. 1. Prehospital Emergency Care Service (SAMU 67), Strasbourg University Hospital, and the Centre for Training and Research in Health Sciences Education (CFRPS), Faculty of Medicine, University of Strasbourg, Strasbourg, France. Electronic address: pelaccia@unistra.fr. 2. Division of Pediatric Emergency Medicine, Department of Pediatrics, McGill University and Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada; Centre for Medical Education, McGill University, Montreal, Quebec, Canada. 3. Unit of Primary Care (UIGP), Unit of Development and Research, Faculty of Medicine, University of Geneva, Geneva, Switzerland. 4. Service of General Internal Medicine, Unit of Development and Research, Faculty of Medicine, University of Geneva, Geneva, Switzerland. 5. Centre for Medical Education, McGill University, Montreal, Quebec, Canada; Department of Neurology, McGill University, Montreal, Quebec, Canada. 6. Li Ka Shing Knowledge Institute, St. Michael's Hospital Library, Toronto, Ontario, Canada. 7. Centre for Medical Education, McGill University, Montreal, Quebec, Canada; School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montreal, Quebec, Canada; Centre for Interdisciplinary Research in Rehabilitation (CRIR) of Greater Montreal, Montreal, Quebec, Canada. 8. Centre for Medical Education, McGill University, Montreal, Quebec, Canada; Department of Medicine, McGill University, Montreal, Quebec, Canada. 9. Centre for Medical Education, McGill University, Montreal, Quebec, Canada; Department of Medicine, McGill University, Montreal, Quebec, Canada; Institut de Recherche Santé et Société, Université catholique de Louvain, Brussels, Belgium.
Abstract
STUDY OBJECTIVE: Clinical reasoning is considered a core competency of physicians. Yet there is a paucity of research on clinical reasoning specifically in emergency medicine, as highlighted in the literature. METHODS: We conducted a scoping review to examine the state of research on clinical reasoning in this specialty. Our team, composed of content and methodological experts, identified 3,763 articles in the literature, 95 of which were included. RESULTS: Most studies were published after 2000. Few studies focused on the cognitive processes involved in decisionmaking (ie, clinical reasoning). Of these, many confirmed findings from the general literature on clinical reasoning; specifically, the role of both intuitive and analytic processes. We categorized factors that influence decisionmaking into contextual, patient, and physician factors. Many studies focused on decisions in regard to investigations and admission. Test ordering is influenced by physicians' experience, fear of litigation, and concerns about malpractice. Fear of litigation and malpractice also increases physicians' propensity to admit patients. Context influences reasoning but findings pertaining to specific factors, such as patient flow and workload, were inconsistent. CONCLUSION: Many studies used designs such as descriptive or correlational methods, limiting the strength of findings. Many gray areas persist, in which studies are either scarce or yield conflicting results. The findings of this scoping review should encourage us to intensify research in the field of emergency physicians' clinical reasoning, particularly on the cognitive processes at play and the factors influencing them, using appropriate theoretical frameworks and more robust methods.
STUDY OBJECTIVE: Clinical reasoning is considered a core competency of physicians. Yet there is a paucity of research on clinical reasoning specifically in emergency medicine, as highlighted in the literature. METHODS: We conducted a scoping review to examine the state of research on clinical reasoning in this specialty. Our team, composed of content and methodological experts, identified 3,763 articles in the literature, 95 of which were included. RESULTS: Most studies were published after 2000. Few studies focused on the cognitive processes involved in decisionmaking (ie, clinical reasoning). Of these, many confirmed findings from the general literature on clinical reasoning; specifically, the role of both intuitive and analytic processes. We categorized factors that influence decisionmaking into contextual, patient, and physician factors. Many studies focused on decisions in regard to investigations and admission. Test ordering is influenced by physicians' experience, fear of litigation, and concerns about malpractice. Fear of litigation and malpractice also increases physicians' propensity to admit patients. Context influences reasoning but findings pertaining to specific factors, such as patient flow and workload, were inconsistent. CONCLUSION: Many studies used designs such as descriptive or correlational methods, limiting the strength of findings. Many gray areas persist, in which studies are either scarce or yield conflicting results. The findings of this scoping review should encourage us to intensify research in the field of emergency physicians' clinical reasoning, particularly on the cognitive processes at play and the factors influencing them, using appropriate theoretical frameworks and more robust methods.
Authors: Ashley L Marchese; Andrew M Fine; Jason A Levy; Michael C Monuteaux; Kenneth A Michelson Journal: Pediatr Emerg Care Date: 2022-02-01 Impact factor: 1.602
Authors: Martina Anto-Ocrah; Richard Gyan Aboagye; Linda Hasman; Ali Ghanem; Seth Owusu-Agyei; Raquel Buranosky Journal: Front Neurol Date: 2022-09-06 Impact factor: 4.086