超越思维的快慢:现实世界实践中临床推理的贝叶斯直觉主义模型。

IF 2.2 Q2 MEDICINE, GENERAL & INTERNAL
Diagnosis Pub Date : 2024-12-10 DOI:10.1515/dx-2024-0169
Isaac K S Ng, Wilson G W Goh, Tow Keang Lim
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引用次数: 0

摘要

临床推理是医学培训和实践的一个典型方面,也是一个在过去几十年中被广泛研究和撰写的主题。然而,到目前为止,临床推理的主要概念化是从认知心理学理论中推断出来的,这些理论已经在人类决策的其他领域得到了发展。迄今为止,理解临床推理的主流模型仍然是双重过程理论,该理论将认知视为一种二分的双系统结构,其中直觉思维是快速、高效、自动但容易出错的,而分析思维是缓慢、费力、逻辑、深思熟虑且可能更准确的。然而,我们发现双重过程模型不仅在基本结构效度上存在显著缺陷,而且在自然临床决策中缺乏实用性和适用性。相反,我们在此提供了另一种以贝叶斯为中心的、直觉主义的临床推理方法,我们认为这种方法更能代表现实世界的临床决策,并提出了基于教学和实践的策略来优化和加强该模型中的临床思维,以提高其在实际实践中的准确性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Beyond thinking fast and slow: a Bayesian intuitionist model of clinical reasoning in real-world practice.

Clinical reasoning is a quintessential aspect of medical training and practice, and is a topic that has been studied and written about extensively over the past few decades. However, the predominant conceptualisation of clinical reasoning has insofar been extrapolated from cognitive psychological theories that have been developed in other areas of human decision-making. Till date, the prevailing model of understanding clinical reasoning has remained as the dual process theory which views cognition as a dichotomous two-system construct, where intuitive thinking is fast, efficient, automatic but error-prone, and analytical thinking is slow, effortful, logical, deliberate and likely more accurate. Nonetheless, we find that the dual process model has significant flaws, not only in its fundamental construct validity, but also in its lack of practicality and applicability in naturistic clinical decision-making. Instead, we herein offer an alternative Bayesian-centric, intuitionist approach to clinical reasoning that we believe is more representative of real-world clinical decision-making, and suggest pedagogical and practice-based strategies to optimise and strengthen clinical thinking in this model to improve its accuracy in actual practice.

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来源期刊
Diagnosis
Diagnosis MEDICINE, GENERAL & INTERNAL-
CiteScore
7.20
自引率
5.70%
发文量
41
期刊介绍: Diagnosis focuses on how diagnosis can be advanced, how it is taught, and how and why it can fail, leading to diagnostic errors. The journal welcomes both fundamental and applied works, improvement initiatives, opinions, and debates to encourage new thinking on improving this critical aspect of healthcare quality.  Topics: -Factors that promote diagnostic quality and safety -Clinical reasoning -Diagnostic errors in medicine -The factors that contribute to diagnostic error: human factors, cognitive issues, and system-related breakdowns -Improving the value of diagnosis – eliminating waste and unnecessary testing -How culture and removing blame promote awareness of diagnostic errors -Training and education related to clinical reasoning and diagnostic skills -Advances in laboratory testing and imaging that improve diagnostic capability -Local, national and international initiatives to reduce diagnostic error
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