Learning Outcomes for Decision Making Skills, and Clinical Reasoning and Judgement

Learning Outcomes for Decision Making Skills, and Clinical Reasoning and Judgement

Level 1 - How the doctor approaches their practice

Level 2 - Outcomes for Decision Making Skills, and Clinical Reasoning and Judgement

Decision making, and clinical reasoning and judgement are activities in which medical undergraduates should be proficient. The new medical graduate must continue to display such skills with the additional burden of increasing responsibility for their decisions and actions. This is undoubtedly one of the most stressful aspects of the transition between undergraduate and PRHO and therefore the achievement of these outcomes to a high standard is essential.

Level 3	This could include: Level 4
Clinical reasoning	How to recognise and define the problem, analyse and interpret information and cope with limitations of information and personal limitations.
Evidence-based medicine	How to seek the best available evidence and keep up to date. How to analyse and interpret evidence and work with guidelines and protocols. Recognising the link between evidence-based medicine and audit and the reasons for variation in clinical practice. Recognising the limitations of EBM
Critical thinking	The importance of adopting an inquisitive and questioning attitude and applying rational processes. Recognising irrationality in oneself and others. The importance of own value judgements and those of patients.
Research and scientific methodologies	Knowledge and appreciation of quantitative and qualitative methodology including the differences between them and their appropriate usage. Using research and scientific methodologies to interpret investigations.
Statistical understanding and application	How to think and communicate quantitatively. Choosing and applying appropriate statistical tests with some understanding of the underlying principles and their strengths and weaknesses.
Creativity / resourcefulness	Creative use of techniques, technologies and methodologies. Demonstration of self-reliance, initiative and pragmatism. The importance of sometimes looking outwith conventional boundaries.
Coping with uncertainty and error in decision making	Appreciating that uncertainty exists and that sources of uncertainty might include: oneself the environment the patient limits of knowledge How to use cognitive and intellectual strategies when dealing with uncertainty and the need to be adaptable to change. How to harness one’s own emotional resilience and courage. The importance of making decisions in partnership with colleagues and patients. An outline of levels of responsibility in the healthcare system.
Prioritising	Knowledge and understanding of the factors influencing priorities. How to prioritise one’s own time as well as prioritising the care of patients both of which include management of tasks, events, time and stress. How to use protocols to aid prioritisation.

Specific Issues

* Experience and literature indicate that using a variety of different assessment techniques is more reliable than use of one only (triangulation). In practice, this observation makes the task easier, since many aspects of medical education require use of a variety of examination types.

* A formative component of each of these is always present (even though not always recognised), and enhances the attempt to assess. In other words, PROCESS may be as important as OUTCOME, and participation in process can legitimately be included in the ratings made for assessment.

Recommended methods of assessment include:
OSCE
OSLER
Portfolios
MEQ
SSMs
Case Discussions

A potential new method of assessment which merits further evaluation in this outcome:
Diagnostic Thinking Inventory