Olgu Temelli Klinik Akıl Yürütme ve Karar Verme

Abstract

Amaç: Klinik akıl yürütmeyi, klinik süreçlerde, indirgemeci olmayan, çok boyutlu, ön yargılardan uzak düşünme ve karar verme becerisi olarak tanımlayabiliriz. Klinik akıl yürütme hekimin sahip olması gereken temel bir yeterliktir. Bu makalede klinik akıl yürütme ve karar verme ile ilgili teorileri, aşamaları, eğitim, ölçme ve değerlendirme yöntemlerini ve klinik akıl yürütmenin tıbbi hata ilişkisini tartışılmış ve ilgili kanıtlar sunulmuştur.

Yöntem: Makale geleneksel derleme yöntemi ile hazırlanmıştır.

Bulgular: Klinik akıl yürütmenin nasıl gerçekleştiği ile ilgili teoriler arasında analitik olmayan (sistem 1), analitik (sistem 2) düşünme ve dual process teorileri kabul görmektedir. Analitik olmayan düşünme, hızlı gerçekleşen, fazla bir zihinsel efor gerektirmeyen sezgisel bir düşünmedir. Analitik düşünmede (sistem 2 düşünme) ise neden sonuç ilişkisi kurularak sonuca varılır. Klinik akıl yürütmede, bilgi toplama, hipotez oluşturma ve hipotezi test etme aşamaları genel bir çerçeve oluşturmaktadır. Klinik akıl yürütme eğitimi için, ilk yıllardan itibaren eğitim aktivitelerinde, ölçme ve değerlendirmelerde bu yeterliğe yönelik çerçeveler/modeller belirlenmeli, kullanımı teşvik edilmelidir. Tıbbi hatalar ile klinik akıl yürütme süreçlerindeki yetersizlikler ilişkilidir. Bu nedenle, eğitim yaklaşımlarında klinik akıl yürütme yetersizlik alanlarını dikkate alınması önemlidir. Klinik akıl yürütme değerlendirmeleri, akıl yürütmenin tüm aşamalarını kapsamalıdır. Klinik akıl yürütmenin değerlendirilmesinde çok sayıda yöntem, soru/sorgulama çerçeveleri belirlenmiştir. Bunlarda temel prensipler, klinik akıl yürütme aşamalarına uygun olarak yapılandırılmış klavuzlar ile akıl yürütmeyi gerektiren soruların sorulmasıdır.

Sonuçlar: Klinik akıl yürütme becerisi, tıbbi hataları azaltarak hasta güvenliğini sağlamak, sağlıkta gereksiz iş ve işlemleri azaltmak, hasta hekim uyuşmazlıkları ve bu nedenle ortaya çıkan şiddet olaylarını önlemek için hekimin sahip olması gereken temel yeterliktir. Öğrenme ve değerlendirme aktiviteleri, klinik akıl yürütme teorilerine ve aşamalarına uygun modeller kullanılarak planlanmalıdır.  

Keywords

• Klinik akıl yürütme
• Olgu temelli çalışma
• Tıp eğitimi

Case-Based Clinical Reasoning And Decision Making

Abstract

Aim: We can define clinical reasoning as the ability to think and decide in clinical processes, which is non-reductive, multidimensional and free from prejudices. Clinical reasoning is a basic competence that a physician should have. In this article, theories about clinical reasoning, stages of clinical reasoning, training and evaluation methods, and the relationship between clinical reasoning and medical malpractice are discussed and related evidence is presented.

Methods: The article was prepared by the traditional review method

Results: Non-analytical (system 1), analytical (system 2) thinking and dual process theories are accepted among the theories of how clinical reasoning is realized. Non-analytical thinking is an intuitive thinking that takes place fast and does not require much mental effort. Analytical thinking (system 2 thinking) is established by establishing a cause-effect relationship. In clinical reasoning, the stages of gathering information, forming hypothesis and testing hypothesis constitute a general framework. For clinical reasoning education, frameworks / models for this competence should be determined in educational activities, assessment and evaluation from the first years, and their use should be encouraged. Medical errors and inadequate clinical reasoning processes are related. For this reason, it is important to consider the clinical reasoning insufficiency areas in educational approaches. Clinical reasoning assessments should cover all stages of reasoning. Numerous methods and question / inquiry frameworks have been identified in the evaluation of clinical reasoning. In these, the basic principles are to ask questions that require reasoning with guides structured in accordance with the clinical reasoning stages.

Conclusions: Clinical reasoning ability is the basic competence that a physician should have in order to ensure patient safety by reducing medical errors, to reduce unnecessary work and procedures in health, to prevent patient physician disputes and therefore violent events. Learning and assessment activities should be planned using models suitable for clinical reasoning terms and stages.

Keywords

• Clinical reasoning
• Case based study
• Medical education

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