Clinical Reasoning in Medicine: A Concept Analysis
Clinical Reasoning in Medicine: A Concept Analysis
复制标题
医学临床推理：概念分析
DOI：
10.22037/jme.v16i3.17755
复制
发表时间：
2017
影响因子：
7.4
通讯作者：
M. H. Abardeh
中科院分区：
文献类型：
--
作者：
S. Yazdani;M. H. Abardeh
背景：临床推理在医生做出诊断和决策的能力中起着重要作用。它被认为是医生最关键的能力，但它是一个模糊的概念，在医学上，需要一个明确的分析和定义。我们的目的是通过识别其组成部分来澄清医学中的临床推理概念，并将其与其他类似概念区分开来。有必要对临床推理有一个可操作的定义，并且必须精确定义其组成部分，以便设计成功的干预措施并在未来的研究中轻松使用。方法：应用麦肯纳的九步模型来澄清临床推理的概念。从多个数据库中检索了1995- 2016年（截至2016年9月）的该概念分析的文献，包括Scopus、Elsevier、PubMed、ISI、ISC、Medline和Google Scholar。使用电子数据库对文献进行了广泛检索。因此，选择了17篇文章和一本书进行审查。我们应用麦肯纳的概念分析方法在研究临床推理，使定义属性，前因和后果，这个概念被提取出来。结果：临床推理在医学中有九个主要属性。这些属性包括：（1）作为认知过程的临床推理;（2）不同类型知识的知识获取和应用;（3）作为临床推理过程的一部分的思维;（4）患者输入;（5）上下文相关和特定领域的过程;（6）迭代和复杂过程;（7）多模态认知过程;（8）专业原则;以及（9）卫生系统任务。这些属性受工作场所背景，实践参考框架，从业者的实践模式和临床技能的影响。临床推理的结果是推理和隐性知识生产的元认知改进。结论：本概念分析试图澄清临床推理在医学中的概念，并减少这一概念的模糊性，设计成功的干预措施，并在未来的研究中使用它。关键词：临床推理，医学，概念分析，麦凯纳模型
Background: Clinical reasoning plays an important role in the ability of physicians to make diagnoses and decisions. It is considered the physician’s most critical competence, but it is an ambiguous concept in medicine that needs a clear analysis and definition. Our aim was to clarify the concept of clinical reasoning in medicine by identifying its components and to differentiate it from other similar concepts. It is necessary to have an operational definition of clinical reasoning, and its components must be precisely defined in order to design successful interventions and use it easily in future research. Methods: McKenna’s nine-step model was applied to facilitate the clarification of the concept of clinical reasoning. The literature for this concept analysis was retrieved from several databases, including Scopus, Elsevier, PubMed, ISI, ISC, Medline, and Google Scholar, for the years 1995– 2016 (until September 2016). An extensive search of the literature was conducted using the electronic database. Accordingly, 17 articles and one book were selected for the review. We applied McKenna’s method of concept analysis in studying clinical reasoning, so that definitional attributes, antecedents, and consequences of this concept were extracted. Results: Clinical reasoning has nine major attributes in medicine. These attributes include: (1) clinical reasoning as a cognitive process; (2) knowledge acquisition and application of different types of knowledge; (3) thinking as a part of the clinical reasoning process; (4) patient inputs; (5) contextdependent and domain-specific processes; (6) iterative and complex processes; (7) multi-modal cognitive processes; (8) professional principles; and (9) health system mandates. These attributes are influenced by the antecedents of workplace context, practice frames of reference, practice models of the practitioner, and clinical skills. The consequences of clinical reasoning are the metacognitive improvement of reasoning and tacit knowledge production. Conclusion: The present concept analysis tries to clarify the concept of clinical reasoning in medicine and reduces the ambiguity of this concept to design successful interventions and use it easily in future research. Keywords: CLINICAL REASONING, MEDICINE, CONCEPT ANALYSIS, MCKENNA’S MODEL