Clinical Reasoning Lecture 2024 PDF

CLINICAL REASONING 2024 | PRIYA SHARP LEARNING OBJECTIVES Identify the different forms of clinical reasoning and understand their application in different contexts of veterinary practice Understand and describe the process of inductive reasoning Develop a strategy for engagi...

CLINICAL REASONING 2024 | PRIYA SHARP LEARNING OBJECTIVES Identify the different forms of clinical reasoning and understand their application in different contexts of veterinary practice Understand and describe the process of inductive reasoning Develop a strategy for engaging with practitioners to develop their own clinical reasoning 2 W H AT I S C L I N I C A L R E A S O N I N G ? “ Clinical reasoning is the process by which veterinary surgeons integrate a multitude of clinical and contextual factors to make decisions about the diagnoses, treatment options and “ prognoses of their patients VINTEN C. E. K. (2020). CLINICAL REASONING IN VETERINARY PRACTICE. VETERINARY EVIDENCE, 5(2). H T T P S : / / D O I. O R G / 1 0. 1 8 8 4 9 / V E.V 5 I 2. 2 8 3 3 THE PROCESS Starts with a presenting case…… Ends with (hopefully) successful treatment 4 HOW DO WE GET CLINICAL REASONING SKILLS? Difficult to teach (sorry about that!) Experience!! Practise Guidance Vets vs Medics BUT… vets are good to go on graduation! 5  TYPES OF CLINICAL REASONING Type 1 Life & Learning Type 2 “Pattern Recognition” “First Principles” Non-analytical Analytical Intuitive Clinical Deductive Rapid decision Inductive Experience Abductive Illness-scripts ↑ Cognitive load Existing solutions Novel situations/ unexpected ↑ error risk? response May, S.A. (2013) Clinical reasoning and case-based decision making: The fundamental challenge to veterinary educators. Journal of Veterinary Medical Education, 40, 200–209. Maddison, J (2017) Chapter 24: Clinical Reasoning Skills in: Veterinary Medical Education: A Practical Guide (p380-395). Hodgson & Pelzer. 6 T Y P E 1 : “ PAT T E R N R E C O G N I T I O N ” Type 1 Clinical Reasoning Non-analytic Occurs quickly and cost effective (if diagnosis correct!) Past experience → “pattern recognition” Weaker in novices Works well for common disorders Patterns of clinical signs Illness scripts 7 T Y P E 2 : A N A LY T I C Type 2 Clinical Reasoning Analytic Takes time (and money!) to investigate Use to double check presumptive diagnoses (based on pattern recognition) Deductive Inductive Abductive  TYPE 1 V S TYPE 2 REASONING Rectal Temp Bacterial 40.8oC Infection! Bacterial Response to infection Viral Inflammatory Pyrexia Response Rectal Temp Non Autoimmune 40.8oC Infectious Hyperthermia Neoplasia 9 INDUCTIVE REASONING Broad generalisations Tentative hypotheses More exploratory Seek appropriate information Structured approach KEY QUESTIONS What is the problem? Define and refine the problem What system is involved and how is it involved? Define and refine the system Where within the system is the problem located? Define the location What is the lesion? Define the lesion T H E M I N I M U M D ATA B A S E “I’ll do bloods” Haematology, serum biochemistry, urinalysis –useful and often essential Think before you jump in Don’t go fishing…. 12 PROBLEM LIST Create a problem list Clarify the clinical problems Aim is to avoid overlooking key clinical signs 13 DEFINE AND REFINE THE PROBLEM What IS the problem? “my dog is vomiting” “my dog is having fits” “my dog has red urine” Owner vs Veterinarian’s perceptions 14 DEFINE AND REFINE THE SYSTEM What systems are involved in causing the clinical sign/s? Primary problem (ie structural) Secondary problem (ie functional) Why does is matter? Diagnoses, diagnostic tools, treatment/management will differ Other questions? Local vs Systemic 15 D E F I N E T H E LO C AT I O N ( W I T H I N T H E S Y S T E M ) Where within that system is the problem? e.g. in a case of vomiting, is it upper or lower GIT? Endoscopy –where is it of value? 16 DEFINE THE LESION PROBLEM V -vascular I -inflammation SYSTEM T -trauma/toxic A -anomaly LOCATION M -metabolic I -infection N -neoplasia LESION… “What is it D -degenerative 17 EXAMPLE OF DIFFERENTIALS LIST Maddison, J (2017) Chapter 24: Clinical Reasoning Skills in: Veterinary Medical Education: A Practical Guide (p380-395). Hodgson & Pelzer. 18 CONCLUSION Use Type 1 and Type 2 clinical reasoning Pattern recognition is valid! Don’t forget what you know… Takes time Learn this process and practise it 19 REFERENCES Maddison, J (2017) Chapter 24: Clinical Reasoning Skills in: Veterinary Medical Education: A Practical Guide (p380-395). Hodgson & Pelzer. May, S.A. (2013) Clinical reasoning and case-based decision making: The fundamental challenge to veterinary educators. Journal of Veterinary Medical Education, 40, 200–209. Vinten C. E. K. (2020). Clinical reasoning in veterinary practice. Veterinary Evidence, 5(2). https://doi.org/10.18849/ve.v5i2.283 20