TY - JOUR
T1 - It Totally Possibly Could Be
T2 - How a Group of Military Physicians Reflect on Their Clinical Reasoning in the Presence of Contextual Factors
AU - Konopasky, Abigail
AU - Ramani, Divya
AU - Ohmer, Megan
AU - Battista, Alexis
AU - Artino, Anthony R.
AU - McBee, Elexis
AU - Ratcliffe, Temple
AU - Durning, Steven J.
N1 - Publisher Copyright:
© 2020 Association of Military Surgeons of the United States. All rights reserved.
PY - 2020/1/7
Y1 - 2020/1/7
N2 - Introduction: Contextual factors (eg, diagnostic suggestion and burnout) can affect physician clinical reasoning performance, leading to diagnostic error. Yet, contextual factors have only recently been studied and none of that work focused on how physicians appraise (ie, evaluate) the clinical situation as they reason. The purpose of this qualitative study was to use appraisal to describe the effect of contextual factors on clinical reasoning. Materials and Methods: Physicians (n = 25) either viewed two video cases or participated in two live scenarios, one with contextual factors and one without. Afterwards, they completed a "think-aloud" reflection while reviewing the cases. Transcribed think-alouds were coded for appraisal markers, comparing cases with and without contextual factors. Results: When contextual factors were present, participants expressed more emotional evaluation and uncertainty about those emotions. Across all types of cases, participants expressed uncertainty about the case and assessed what "could" or "would" have gone differently. Conclusions: This study suggests that one major effect of contextual factors may be that they induce emotions, which may affect the process of clinical reasoning and diagnostic error. It also suggests that uncertainty may be common in clinical practice, and we should thus further explore its impact.
AB - Introduction: Contextual factors (eg, diagnostic suggestion and burnout) can affect physician clinical reasoning performance, leading to diagnostic error. Yet, contextual factors have only recently been studied and none of that work focused on how physicians appraise (ie, evaluate) the clinical situation as they reason. The purpose of this qualitative study was to use appraisal to describe the effect of contextual factors on clinical reasoning. Materials and Methods: Physicians (n = 25) either viewed two video cases or participated in two live scenarios, one with contextual factors and one without. Afterwards, they completed a "think-aloud" reflection while reviewing the cases. Transcribed think-alouds were coded for appraisal markers, comparing cases with and without contextual factors. Results: When contextual factors were present, participants expressed more emotional evaluation and uncertainty about those emotions. Across all types of cases, participants expressed uncertainty about the case and assessed what "could" or "would" have gone differently. Conclusions: This study suggests that one major effect of contextual factors may be that they induce emotions, which may affect the process of clinical reasoning and diagnostic error. It also suggests that uncertainty may be common in clinical practice, and we should thus further explore its impact.
UR - http://www.scopus.com/inward/record.url?scp=85079823756&partnerID=8YFLogxK
U2 - 10.1093/milmed/usz250
DO - 10.1093/milmed/usz250
M3 - Article
C2 - 32074314
AN - SCOPUS:85079823756
SN - 0026-4075
VL - 185
SP - 575
EP - 582
JO - Military Medicine
JF - Military Medicine
ER -