Making sense of clinical reasoning: judgement and the evidence of the senses
Making sense of clinical reasoning: judgement and the evidence of the senses
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DOI：
10.1046/j.1365-2923.2003.01542.x
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发表时间：
2003-06-01
影响因子：
6
通讯作者：
Marshall, R
中科院分区：
文献类型：
--
作者：
Bleakley, A;Farrow, R;Marshall, R
研究背景近距离注意是医学视觉领域的一项重要工作能力，是对不同性质的事物进行敏锐的辨别和判断。这种通用能力通常是假定的，其细节是通过经验来发展的，就像传统的专业学徒一样。辨别力是情感领域学习的结果，并为临床工作引入了一个重要的美学维度，与医学人文学科的兴趣保持一致。美学方法的临床推理，但是，仍然在很大程度上未被探索作为一个明确的重点为medical education.Framework和实践的悖论我们提供了一个框架，明确的教育知觉歧视在视觉领域作为一种形式的实践“艺术”，把表面“看”到更深的“看”。然而，这样的教育引起了某些悖论。虽然新手通常“看到”他们期望在视觉图像中看到的东西（体征和症状），但专家也会犯类似的错误。此外，专家们开始熟悉在诊断中使用视觉识别，例如生动的自然参照物，以帮助快速模式识别，包括诊断“一瞥”，但这似乎违背了描述你所看到的第一原则。运用想象力作为一种隐性的认知形式，“准备”和增强感知，我们建议，然而，明智地使用这种知识可以是积极的。此外，视觉领域的临床判断过程的机制可以详细说明，以告知教育议程。另一个悖论是，专家同时使用特殊的方法和协议驱动的做法，这些似乎提供了矛盾的方法来获得知识。我们认识到这是医学的固有的不确定性的一个方面，在面对复杂的，模糊的和独特的材料，必须通过临床education.Conclusion解决，我们等同于“美学”与“感性”和描述临床专业知识为“鉴赏”的信息图像。这种鉴赏力是一种特殊的认识形式，反过来又可以被定义为一种影响艺术实践的审美敏感性。它可以被阐明和分析，为教育改进提供基础。鉴赏不是一种技术理性的过程，而是一种内在的悖论，这种悖论可以被视为一种教育资源，而不是一种障碍。
Background Close noticing, as keen discrimination and judgement between qualities, is a key capability for work in visual domains in medicine. This generic capability is normally assumed, and its specifics are left to develop through experience, as traditional apprenticeship in a specialty. Discrimination is an outcome of learning in the affective domain, and introduces a vital aesthetic dimension to clinical work that aligns with the interests of the medical humanities. An aesthetic approach to clinical reasoning, however, remains largely unexplored as an explicit focus for medical education.Framework and practice paradoxes We offer a framework for an explicit education of perceptual discrimination in the visual domain as a form of practice 'artistry', turning a surface 'looking' into a deeper 'seeing'. Such an education, however, raises certain paradoxes. While novices typically 'see' what they expect to see in visual images (sign and symptom), experts also make similar errors. Further, experts become familiar with the use of visual heuristics in diagnosis, such as vivid natural referents to aid in rapid pattern recognition in an encompassing diagnostic 'glance', yet this appears to defeat the first principle of describing what you see. Employing a model of imagination as a tacit form of knowing that 'prepares' and enhances perception, we suggest, however, that the judicious use of such heuristics can be positive. Moreover, the mechanics of the process of clinical judgement in visual domains can be detailed to inform educational agendas. A further paradox is that of experts using both idiosyncratic heuristics and protocol-driven practices, where these seem to offer contradictory approaches to gaining knowledge. We recognise this as a facet of medicine's inherent uncertainty, in the face of complex, ambiguous and unique material, that must be addressed through clinical education.Conclusion We equate 'aesthetics' with 'sensibility' and describe clinical expertise as 'connoisseurship' of informational images. Such connoisseurship, a particular form of knowing, can, in turn, be defined as an aesthetic sensibility informing practice artistry. It can be articulated and analysed to provide a basis for educational enhancement. Connoisseurship is not a technical-rational procedure but is inherently paradoxical and such paradox may be valued as an educational resource, rather than seen as a hindrance.