Meral Demirören1, Özden Palaoğlu2

Abstract

Clinical Reasoning, the core element of clinical competency, is the integration and synthesis of data derived from a clinical case with knowledge and experience of doctor/student, to be used in diagnosis and patient management. Since Clinical Reasoning is one of the main learning outcomes of undergraduate medical education and one of the main components of the medical education reform, the educational attempts to distinguish medical students Clinical Reasoning skills and attempts to follow up and evaluate its efficacies are gaining more importance. With the present review, it is aimed to explain clinical reasoning models, and approachs to learning-teaching and assesment methods of clinical reasoning skills.

Keywords

• Clinical reasoning, medical education

KLİNİK AKIL YÜRÜTME MODELLERİ, ÖĞRETİMİ VE DEĞERLENDİRİLMESİ

Abstract

Klinik yeterliğin merkezi bileşenini oluşturan klinik akıl yürütme (KAY), bir klinik vakadan elde edilen bilgilerin, hekimin/öğrencinin bilgisi ve deneyimi ile entegre edilmesi, sentez edilmesi ve hastanın probleminin teşhisinde ve hastanın yönetiminde kullanılmasıdır. KAY, mezuniyet öncesi tıp eğitiminin temel öğrenme çıktılarından biri olması ve tıp eğitimi reformlarının temel bileşenlerinden birini oluşturması nedeniyle, tıp öğrencilerine KAY becerisini kazandırmaya yönelik öğretimsel çabalarla, kazanımların izlenmesi ve değerlendirilmesine yönelik çabalar giderek daha fazla yer almakta ve önem kazanmaktadır. Bu derleme ile, KAY modellerinin açıklanması, KAY becerisini öğrenme-öğretme ve ölçme yaklaşımları hakkında bilgi verilmesi amaçlanmıştır.

Keywords

• Klinik akıl yürütme, tıp eğitimi

References

1. Instutute For International Medical Education. “Global Minumum Essential Requirements in Medical Education. Medical Teacher 2002;24(2):130-135.
2. Maudsley G, Strivens EJ. „Science‟, „critical thinking‟ and „competence‟ for Tomorrow‟s Doctors. A reviw of terms and concepts. Medical Education 2000;34:53-60.
3. Stern DT, Ben-David MF, Norgini J, Wojtczak A, Schwarz MR. Setting school-level outcome standarts. Medical Education 2006;40:166-172.
4. Van Der Vleuten CPM, Schuwirth LWT. Assesing professional competence: From methods to programmes. Medical Education 2005;39:309-317.
5. Groves M, Scott I, Alexander H. Assesing clinical reasoning: A methot to monitor its development in a PBL curriculum. Medical Taecher 2002; 24(5):507-515.
6. Higgs J. A programme for developing clinical reasoning skills in graduate physiotherapists. Medical Teacher 1993;15:142-159.
7. Round A. Introduction to clinical reasoning. Journal of Evaluation in Clinical Practice 2001;7(2):109- 117.
8. Higgs J, Jones M. Clinical reasoning in the health professions. Second Education. Publisher:Butterworth-Heinemann, 2000.

9. Eshach H, Bitterman H. From case-based reasoning to problem-based learning. Academic Medicine 2003;78(5):491-496.
10. Charlin B, Tardif J, Boshuizen HPA. Scripts and medical diagnostic knowledge: Theory and applications for clinical reasoning instruction and research. Academic Medicine 2000;75(2):182-190.
11. Coderre S, Mandin H, Harasym PH, Fick GH. Diagnostic reasoning strategies and diagnostic success. Medical Education 2003;37:695-703.
12. Beullens J, Strufy E & Van Damme B. Do extended matching multiple-choice questions measure clinical reasoning?. Medical Education 2005;39:410-417.
13. Hmelo CE, Gotterer GS, Bransford JD. Atheory-driven approach to assesing the cognitive affects of PBL. Instructional Science 1997;25:387-408.
14. Magnani L. Basic science reasoning and clinical reasoning interwined: epistemological analysis and consequences for medical education. Advances in Health Sciences Education 1997;2:115-130.
15. Arts JAR, Gijselaers WH, Segers MSR. Enhancing problem solving expertise by means of an authentic, collaborative, computer supported and problem-based course. European Journal of Psychology of Education 2006;1:71-90.
16. Bowen JL. Educational Strategies to promote Clinical Diagnostic Reasoning. The New England Journal of Medicine 2006;355:2217-2225.
17. Eva KW. What every teacher needs to know about clinical reasoning. Medical Education 2004;39:98- 106.
18. Forde R. Competing conceptions of diagnostic reasoning – is there a way out? Theoritical Medicine and Bioethics 1998;19:59-72. 10