■管理推理是临床推理的一个独特子集。我们试图探索在设计管理推理评估时要考虑的功能。
■这是一项混合的实证研究,叙事回顾,和专家视角。在2021年,我们回顾并讨论了10个模拟(分阶段)医患相遇的视频,积极寻求能够为管理推理评估提供见解的行动。我们结合临床推理评估的文献分析了我们自己的观察结果,使用恒定的比较定性方法。
■将影响其评估的管理推理的区别特征包括管理脚本,共同决策,过程知识,特定疾病知识,和定制的接触和管理计划。值得特别考虑的性能领域包括沟通,整合患者偏好,坚持管理脚本,和预测。遇到变化的其他方面包括临床问题,临床和非临床患者特征(包括偏好,值,和资源),团队/系统特征,遇到特征。我们对几种相关的评估方法进行了分类,包括书面/基于计算机的评估方法,基于模拟,和基于工作场所的模式,和各种新颖的响应格式。
■可以通过关注性能领域来改进管理推理的评估,变化的方面,以及本文确定的各种方法。
UNASSIGNED: Management reasoning is a distinct subset of clinical reasoning. We sought to explore features to be considered when designing assessments of management reasoning.
UNASSIGNED: This is a hybrid empirical research study, narrative review, and expert perspective. In 2021, we reviewed and discussed 10 videos of simulated (staged) physician-patient encounters, actively seeking actions that offered insights into assessment of management reasoning. We analyzed our own observations in conjunction with literature on clinical reasoning assessment, using a constant comparative qualitative approach.
UNASSIGNED: Distinguishing features of management reasoning that will influence its assessment include management scripts, shared decision-making, process knowledge, illness-specific knowledge, and tailoring of the encounter and management plan. Performance domains that merit special consideration include communication, integration of patient preferences, adherence to the management script, and prognostication. Additional facets of encounter variation include the clinical problem, clinical and nonclinical patient characteristics (including preferences, values, and resources), team/system characteristics, and encounter features. We cataloged several relevant assessment approaches including written/computer-based, simulation-based, and workplace-based modalities, and a variety of novel response formats.
UNASSIGNED: Assessment of management reasoning could be improved with attention to the performance domains, facets of variation, and variety of approaches herein identified.