Management Reasoning: Implications for Health Professions Educators and a Research Agenda

David A. Cook, Steven J. Durning, Jonathan Sherbino, Larry D. Gruppen

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Substantial research has illuminated the clinical reasoning processes involved in diagnosis (diagnostic reasoning). Far less is known about the processes entailed in patient management (management reasoning), including decisions about treatment, further testing, follow-up visits, and allocation of limited resources. The authors' purpose is to articulate key differences between diagnostic and management reasoning, implications for health professions education, and areas of needed research.Diagnostic reasoning focuses primarily on classification (i.e., assigning meaningful labels to a pattern of symptoms, signs, and test results). Management reasoning involves negotiation of a plan and ongoing monitoring/adjustment of that plan. A diagnosis can usually be established as correct or incorrect, whereas there are typically multiple reasonable management approaches. Patient preferences, clinician attitudes, clinical contexts, and logistical constraints should not influence diagnosis, whereas management nearly always involves prioritization among such factors. Diagnostic classifications do not necessarily require direct patient interaction, whereas management prioritizations require communication and negotiation. Diagnoses can be defined at a single time point (given enough information), whereas management decisions are expected to evolve over time. Finally, management is typically more complex than diagnosis.Management reasoning may require educational approaches distinct from those used for diagnostic reasoning, including teaching distinct skills (e.g., negotiating with patients, tolerating uncertainty, and monitoring treatment) and developing assessments that account for underlying reasoning processes and multiple acceptable solutions.Areas of needed research include if and how cognitive processes differ for management and diagnostic reasoning, how and when management reasoning abilities develop, and how to support management reasoning in clinical practice.

Original languageEnglish (US)
Pages (from-to)1310-1316
Number of pages7
JournalAcademic medicine : journal of the Association of American Medical Colleges
Volume94
Issue number9
DOIs
StatePublished - Sep 1 2019

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profession
educator
diagnostic
health
management
monitoring
management decision
information management
uncertainty
communication
ability
Teaching
interaction
resources

ASJC Scopus subject areas

  • Education

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Management Reasoning : Implications for Health Professions Educators and a Research Agenda. / Cook, David A.; Durning, Steven J.; Sherbino, Jonathan; Gruppen, Larry D.

In: Academic medicine : journal of the Association of American Medical Colleges, Vol. 94, No. 9, 01.09.2019, p. 1310-1316.

Research output: Contribution to journalArticle

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