Clinical reasoning of junior doctors in emergency medicine: a grounded theory study

Adams, E., Goyder, C., Heneghan, C., Brand, L. and Ajjawi, R. 2017, Clinical reasoning of junior doctors in emergency medicine: a grounded theory study, Emergency medicine journal, vol. 34, no. 2, pp. 70-75, doi: 10.1136/emermed-2015-205650.

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Title Clinical reasoning of junior doctors in emergency medicine: a grounded theory study
Author(s) Adams, E.
Goyder, C.
Heneghan, C.
Brand, L.
Ajjawi, R.ORCID iD for Ajjawi, R.
Journal name Emergency medicine journal
Volume number 34
Issue number 2
Start page 70
End page 75
Total pages 6
Publisher BMJ Publishing Group
Place of publication London, Eng.
Publication date 2017-02
ISSN 1472-0213
Keyword(s) clinical assessment, education
education, teaching
emergency departments
Decision Making
Emergency Medicine
Focus Groups
Grounded Theory
Internship and Residency
Interviews as Topic
Medical Staff, Hospital
Summary INTRODUCTION: Emergency medicine (EM) has a high case turnover and acuity making it a demanding clinical reasoning domain especially for junior doctors who lack experience. We aimed to better understand their clinical reasoning using dual cognition as a guiding theory. METHODS: EM junior doctors were recruited from six hospitals in the south of England to participate in semi-structured interviews (n=20) and focus groups (n=17) based on recall of two recent cases. Transcripts were analysed using a grounded theory approach to identify themes and to develop a model of junior doctors' clinical reasoning in EM. RESULTS: Within cases, clinical reasoning occurred in three phases. In phase 1 (case framing), initial case cues and first impressions were predominantly intuitive, but checked by analytical thought and determined the urgency of clinical assessment. In phase 2 (evolving reasoning), non-analytical single cue and pattern recognitions were common which were subsequently validated by specific analytical strategies such as use of red flags. In phase 3 (ongoing uncertainty) analytical self-monitoring and reassurance strategies were used to precipitate a decision regarding discharge. CONCLUSION: We found a constant dialectic between intuitive and analytical cognition throughout the reasoning process. Our model of clinical reasoning by EM junior doctors illustrates the specific contextual manifestations of the dual cognition theory. Distinct diagnostic strategies are identified and together these give EM learners and educators a framework and vocabulary for discussion and learning about clinical reasoning.
Language eng
DOI 10.1136/emermed-2015-205650
Field of Research 130202 Curriculum and Pedagogy Theory and Development
130209 Medicine, Nursing and Health Curriculum and Pedagogy
1103 Clinical Sciences
1110 Nursing
1117 Public Health And Health Services
Socio Economic Objective 930102 Learner and Learning Processes
HERDC Research category C1 Refereed article in a scholarly journal
Copyright notice ©2016, BMJ Publishing Group Limited
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