TY - JOUR
T1 - Assessment of management reasoning
T2 - Design considerations drawn from analysis of simulated outpatient encounters
AU - Cook, David A.
AU - Durning, Steven J.
AU - Stephenson, Christopher R.
AU - Gruppen, Larry D.
AU - Lineberry, Matt
N1 - Publisher Copyright:
© 2024 Mayo Foundation.
PY - 2024
Y1 - 2024
N2 - Purpose: Management reasoning is a distinct subset of clinical reasoning. We sought to explore features to be considered when designing assessments of management reasoning. Methods: This is a hybrid empirical research study, narrative review, and expert perspective. In 2021, we reviewed and discussed 10 videos of simulated (staged) physician-patient encounters, actively seeking actions that offered insights into assessment of management reasoning. We analyzed our own observations in conjunction with literature on clinical reasoning assessment, using a constant comparative qualitative approach. Results: Distinguishing features of management reasoning that will influence its assessment include management scripts, shared decision-making, process knowledge, illness-specific knowledge, and tailoring of the encounter and management plan. Performance domains that merit special consideration include communication, integration of patient preferences, adherence to the management script, and prognostication. Additional facets of encounter variation include the clinical problem, clinical and nonclinical patient characteristics (including preferences, values, and resources), team/system characteristics, and encounter features. We cataloged several relevant assessment approaches including written/computer-based, simulation-based, and workplace-based modalities, and a variety of novel response formats. Conclusions: Assessment of management reasoning could be improved with attention to the performance domains, facets of variation, and variety of approaches herein identified.
AB - Purpose: Management reasoning is a distinct subset of clinical reasoning. We sought to explore features to be considered when designing assessments of management reasoning. Methods: This is a hybrid empirical research study, narrative review, and expert perspective. In 2021, we reviewed and discussed 10 videos of simulated (staged) physician-patient encounters, actively seeking actions that offered insights into assessment of management reasoning. We analyzed our own observations in conjunction with literature on clinical reasoning assessment, using a constant comparative qualitative approach. Results: Distinguishing features of management reasoning that will influence its assessment include management scripts, shared decision-making, process knowledge, illness-specific knowledge, and tailoring of the encounter and management plan. Performance domains that merit special consideration include communication, integration of patient preferences, adherence to the management script, and prognostication. Additional facets of encounter variation include the clinical problem, clinical and nonclinical patient characteristics (including preferences, values, and resources), team/system characteristics, and encounter features. We cataloged several relevant assessment approaches including written/computer-based, simulation-based, and workplace-based modalities, and a variety of novel response formats. Conclusions: Assessment of management reasoning could be improved with attention to the performance domains, facets of variation, and variety of approaches herein identified.
KW - Diagnostic reasoning
KW - clinical decision-making
KW - diagnostic errors
KW - education, medical
KW - reproducibility of results
KW - therapeutic reasoning
KW - validation studies as topic
UR - http://www.scopus.com/inward/record.url?scp=85190440307&partnerID=8YFLogxK
U2 - 10.1080/0142159X.2024.2337251
DO - 10.1080/0142159X.2024.2337251
M3 - Article
AN - SCOPUS:85190440307
SN - 0142-159X
JO - Medical Teacher
JF - Medical Teacher
ER -