Do you see the forest or the trees clinical reasoning and the kfp. medical education experts electricity production in the us


It is a wonderful experience when you are listening to a speaker and the ‘switch flicks on’. It might be the way they are speaking, the knowledge they are conveying, and/or the contribution of other participants that connects all the circuits together to light up your cognition. I had such an experience this week during a session on Clinical Reasoning by the inspiring Dr Genevieve Yates.

We were discussing how to unpack clinical reasoning, particularly with regards to assisting doctors to improve their clinical reasoning approach (and for many, their approach to the Key Features Paper). The approach to this exam is often compared to the decision-making required to climb a tree to ‘reach the diagnosis’, where we start at the broad-based trunk, and are required to make decisions based on the prominent ‘key-features’ at the intersection of each branch. This is diagnostic reasoning. gas 85 vs 87 The exam (and our clinical practice), also includes therapeutic reasoning – the decisions we make around treatment and management that are often informed by additional information the non-clinical domains of general practice. What struck me as we spoke was why so many doctors have difficulty with this exam – trees don’t grow in isolation.

We use these clues in our day to day practice to inform our reasoning – but on paper (as in an exam) the ecosystem can be harder to define. We are unaware of the environment in which the patient is presenting. electricity worksheets grade 6 We don’t have their past history or that ‘spidy sense’. As GP’s we see the most undifferentiated of presentations and we use one of two Systems in our brain to define the diagnosis. Understanding these systems can help to refine our clinical reasoning approach.

• This is an intuitive system where we use heuristics (mental short-cuts), rules of thumb, and diagnoses ‘matched’ without memory and learned examples (which may be inadequate or incorrect). It is fast, associative, inductive, frugal, and has a large affective (‘gut’) component that is highly related to context. 5 gas laws There is minimal uncertainty. But how do we know when it isn’t going to work?

Diagnostic failure reflects diagnostic uncertainty (which is more likely in undifferentiated presentations) and is therefore highest in GP, Emergency and internal medicine. Our specialist colleagues (outside of GP) deal with much less uncertainty (excepting perhaps in ICU, trauma, surgery and internal medicine). Good doctors need a combination of sound judgement, well-calibrated decision making and effective problem solving to reach a diagnosis. This requires an awareness of which ‘system’ we are using because if there is an unrecognised change in context and we defer to pattern-recognising without thinking – we’ll miss something.

As doctors, overconfidence sits well with us. We like it as it leads to a decision. gasbuddy trip Overconfidence fits well with System 1 emotive thinking as positive feelings increase confidence. It also fits well with confirmation bias – we make a diagnosis, gather information to support it, and then feel more confident! It is much easier mentally to be certain. If we are overconfident, we become biased in the way that we gather information to support a hypothesis. Sadly, the culture of medicine does little to support less confident doctors that are often seen as vulnerable – thus perpetuating the persona of the confident doctor. Other variables that impact upon confidence include ego bias, gender, culture, personal ability, level of task difficulty, availability bias, outcome predictability, and attribution bias.

BUT overconfidence is related to unconscious incompetence – what we don’t know we don’t know. electricity outage houston tx So we need to develop strategies for DEBIASING – forcing us to consider alternative diagnoses and opposing strategies. Unfortunately one debiasing strategy the current generation has developed is online access ( see article). This is again a trap for young players as searching in itself is often based on confirmation bias.

For those who’s lives are currently overwhelmed by KFP study, considering the importance of your diagnostic ecosystem will help you to understand the importance of specific answers, demonstrating the breadth of your knowledge and safety in practice. The assessment is about demonstrating how well you can climb the tree, and not relying on whether it was a bright sunny day when you went to work that morning, and only the regular trees would need climbing.