Clinical Reasoning

Clinical reasoning is osteopathic medicine incorporates themes such as:

• It is guided by the osteopathic tenets:

  • The body is a unit; the person is a unit of body, mind, and spirit.

  • The body is capable of self-regulation, self-healing, and health maintenance.

  • Structure and function are reciprocally interrelated.

  • Rational treatment is based upon an understanding of the basic principles of body unity, self-regulation, and the interrelationship of structure and function.

• Its aim is to guide selection of appropriate treatment or management reather than to name a single diagnosis or condition.

• It is impacted by many contexts. Examples: the patient's context, the practitioner's context, the community context, etc.

• It occurs in three stages: data gathering, clinical decision-making, and metacognitive reflection on the process and its outcomes.

• It calls on a number of meta-skills. Examples: emotional intelligence, analytic thinking, hypothesis generation, pattern recognition, reflexivity, metacognition, etc.

With clinical reasoning activities, it helps if students can see the big picture. How do these things that feel like rote tasks or busy work realistically tie to later clinical team performance? To help provide this "architecture," suggest three repeating global "objectives" for these activities. Below, we show how each of these broad objectives might have more specific activity objectives nested underneath. These broad categories can then be applied to assessment instruments to ensure that each objective is being assessed.

Broad Objective 1 - To develop clinical judgment

• Generate prioritized differential diagnoses

• Justify diagnostic and managment decisions using clinical evidence

• Revise diagnostic thinking as new clinical information emerges

• Present and defed clinical reasoning

• Reflect on diagnostic uncertainty and cognitive bias

Broad Objective 2 - To communicate clinical thinking

• Explain medical concepts clearly to peers

• Participate effectively in collaborative case discussions

• Teach assigned clinical topics to team members

• Communicate clinical reasoning in professional dialogue

• Respond thoughtfully to impromptu questions and dicussion

Broad Objective 3 - To contribute to team-based care

• Prepare independently for team-based clinical discussions

• Present patient cases concisely and professionally

• Contribute meaningfully to team problem-solving

• Demonstrate accountability to peers and faculty

• Engage confidently in authentic clinical learning activities