Factors associated with clinical reasoning ability

Maureen Cahill MCahill at NCSBN.ORG
Wed Aug 31 18:12:30 UTC 2016


That may be the case, but it is a good starting point at identifying measurable, group-identified, and valued behaviors.
Maureen

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From: Hamm, Robert M. (HSC) [mailto:Robert-Hamm at OUHSC.EDU]
Sent: Wednesday, August 31, 2016 10:46 AM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
Subject: Re: [IMPROVEDX] Factors associated with clinical reasoning ability

These are very relevant questions.
One has to worry that relying on physician’s self report is not a way to accurately measure these behaviors.

Rob Hamm

From: Mark Graber [mailto:mark.graber at IMPROVEDIAGNOSIS.ORG]
Sent: Wednesday, August 31, 2016 8:38 AM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
Subject: Re: [IMPROVEDX] Factors associated with clinical reasoning ability

Thanks for sharing Dr Manesh’ survey, Shantanu.

If the goal is to assess their clinical reasoning, I’d like to see other questions, like these:
            When confronted with a new diagnostic challenge, I regularly construct (and document) a differential diagnosis
            When I’m not sure of a diagnosis or ’the next step', I get a second opinion from a peer
            When I’ve reached a tentative diagnosis, I consider whether my conclusion might have been influenced by a cognitive bias

If the goal is broader, looking at success in the diagnostic process, there are other key behaviors that are relevant:
            Have I succeeded in making the patient a partner in the diagnostic process?
            Does my patient know when, why, and how to get back to me if the symptoms persist, change or don’t respond to treatment?
            How often do I personally interact with the radiologists or pathologists interpreting diagnostic tests on my patients?
            According to independent surveys, how effectively am I communicating with my patients?
            Do I keep a record of tests and consults ordered and make sure I close the loop on all of these?
            Do I designate a surrogate to review returning test results if I’m going on vacation?

It would be great to hear from others on the listserv about this.  What observable behaviors characterize clinicians who excel at diagnosis?

Mark


Mark L Graber MD FACP
Senior Fellow, RTI International
Professor Emeritus, SUNY Stony Brook
President, Society to Improve Diagnosis in Medicine




On Aug 30, 2016, at 4:57 PM, Shantanu Nundy <shantanu at HUMANDX.ORG<mailto:shantanu at humandx.org>> wrote:

Colleagues,
Our collaborators at Johns Hopkins will soon be leading a national study to validate the Human Diagnosis Project (Human Dx) open case collaboration platform as a tool for measuring clinical reasoning ability.

Part of this initial study includes surveying physicians and trainees to collect data on factors known or strongly suspected to be associated with clinical reasoning ability, including structural factors (e.g., years of practice, practice setting) and physician attitudes, beliefs, and behaviors.

Dr. Reza Manesh, one of the PIs for the study, copied here, is interested in getting feedback from this group on a late draft of the survey. See attached.

Thank you in advance for your insights,
Shantanu Nundy, MD

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