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Building clinical decision-making skills

机译：建立临床决策技巧

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摘要

The purpose of this discussion is to elucidate several powerful tools of the expert to support and focus diagnostic reasoning of learners and novice health care professionals. Use of these methods serves to focus the thinking of the learner to direct them to pursue useful pathways of investigation and emphasize the likelihood of one illness over others.ELEMENTS USED IN DIAGNOSTIC REASONING As learners progress from students to physicians, they develop and mature skills in clinical decision-making and problem-solving. A number of steps are involved—most importantly experience, exposure to many different clinical situations, and the benefits gained from the direction of an experienced teacher.The initial step is learning the importance of semantic qualifiers (1,2), which are sets of terms that describe the presentation of a clinical problem. Semantic qualifiers assist in problem representation. These qualifiers are abstract concepts, often opposites, called forth in medicine to assist in applying experience to help reach and define a medical decision. The qualifiers may supply critical differentiating evidence for the assignment of an illness into existing medical categories. Examples of semantic qualifiers are: acute versus chronic, previously well versus chronically ill, productive cough versus dry cough, sharp versus dull pain, progressive versus unchanged (the semantic qualifiers are in italics) (3).Semantic qualifiers are applied to the patient description and facilitate thinking about the problem, summarizing the problem and its solution, and defining the clinical problem. Using semantic qualifiers, a case may be seen and interpreted differently by a novice in contrast to an experienced master. Consider the radiology example of a 35-year-old female patient who presents for an ultrasound examination of a lower abdominal wall mass. Initial considerations are quite broad and include diverse processes such as hernia, abscess, lipoma, hem-atoma, endometrioma, metastases, and desmoid. Helpful semantic qualifiers include acute versus chronic, and painful versus nonpainful. The experienced physician, upon learning that this mass is chronic and painful, would then use additional semantic qualifiers regarding the painful nature, such as continuous versus intermittent, to determine that this intermittently (cyclic) painful mass likely represents an endometrioma.
机译：本讨论的目的是阐明专家的几个强大工具，以支持和关注学习者和新手保健专业人员的诊断推理。使用这些方法的用途是将学习者的思想集中起来，指导他们追求调查的有用途径，并强调一个疾病对他人的可能性。作为学习者从学生对医生的进步时，他们的诊断推理中使用的可能性，他们发展和成熟的技能临床决策和解决问题。涉及许多步骤 - 最重要的是经验，暴露于许多不同的临床情况，以及从经验丰富的教师的方向获得的益处。初步一步是学习语义限定员（1,2）的重要性，这是一组描述临床问题呈现的术语。语义限定员有助于问题表示。这些限定符是抽象概念，通常对立，在医学中呼吁，以协助应用经验，帮助达到和定义医疗决定。限定符可以向现有的医疗类别分配疾病的批判性差异。语义素质的例子是：急性与慢性，先前与慢性咳嗽的慢性，慢咳，急剧与沉闷的疼痛，渐变相比（语义限定员在斜体）（3）。患者描述应用于患者描述并促进思考问题，总结问题及其解决方案，并定义临床问题。使用语义限定员，与经验丰富的主人相比，可以通过新手看到和解释和解释和解释。考虑一名35岁女性患者的放射性实例，呈现出对腹壁质量的超声检查。初步考虑非常广泛，包括不同的过程，如疝气，脓肿，脂肪瘤，下摆种子，子宫内膜瘤，转移和DESmoid。有用的语义限定员包括急性与慢性，痛苦的与非珍贵。经验丰富的医生，在学习这种质量是慢性和痛苦之后，然后使用额外的语义限定犬对痛苦的性质，例如连续与间歇性，以确定这种间歇性（环状）疼痛的质量可能代表子宫内膜异位瘤。

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  • 来源
    《Academic radiology》 |2013年第11期|共4页
  • 作者

    WoodB.P.; DeitteL.;

  • 作者单位

    University of Southern California Los Angeles CA United States;

    University of Florida College of Medicine Box 100374 Gainesville FL 32610 United States;

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  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类 放射医学;
  • 关键词

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