J Adv Med Educ Prof. 2020 Apr;8(2):61-71. doi: 10.30476/jamp.2020.82230.1050.

A novel model of clinical reasoning: cognitive zipper model.

Journal of advances in medical education & professionalism

Shahram Yazdani, Maryam Hoseini Abardeh

PMID: 32426390 PMCID: PMC7188939 DOI: 10.30476/jamp.2020.82230.1050

Abstract

INTRODUCTION: Clinical reasoning is a vital aspect of physician competence. It has been the subject of academic research for decades, and various models of clinical reasoning have been proposed. The aim of the present study was to develop a theoretical model of clinical reasoning.

METHODS: To conduct our study, we applied the process of theory synthesis in accordance with the Walker and Avant's approach. First, we considered clinical reasoning as a focal concept of our study. Second, a search was carried out for the period 1984-2018, using the PubMed, Google Scholar, PsycINFO, ERIC, ScienceDirect and Web of Science databases to review the literature to identify factors related to the clinical reasoning and the nature of their relationships. Third, we organized clinical reasoning into an integrated and efficient representation of the clinical reasoning.

RESULTS: According to this study clinical reasoning is the iterative process of intermediation between the recalled clinical knowledge and the patient's represented problem in the clinicians' active memory. We analogize the process of clinical reasoning to the process of closure of a cognitive zipper. The recalled knowledge in clinician's memory resembles to one side of zippers teeth and the evolving representation of the patient's problem resembles the other side of zippers teeth. So, the results of this study are presented in three models: [1] multi-layer knowledge structure model, [2] problem representation model and [3] cognitive zipper model of diagnostic reasoning.

CONCLUSION: We propose a developmental model of clinical reasoning. Several studies have tried to present models and theories to clarify clinical reasoning, but it seems that these theories and models could only explain part of this complex process and not the whole process. Cognitive zipper model, due to its developmental structure, can illustrate the clinical reasoning process in more details than other models do.

Copyright: © 2020: Journal of Advances in Medical Education & Professionalism.

Keywords: Clinical decision making ; Judgment; Problem solving

References

1. Acad Med. 1999 Oct;74(10 Suppl):S138-43 - PubMed
2. Psychol Res. 1989;51(3):129-35 - PubMed
3. Med Educ. 2012 May;46(5):454-63 - PubMed
4. Med Educ. 2011 Sep;45(9):927-38 - PubMed
5. Med Educ. 2005 Apr;39(4):418-27 - PubMed
6. Kaohsiung J Med Sci. 2008 Jul;24(7):341-55 - PubMed
7. J Gen Intern Med. 2005 Sep;20(9):793-9 - PubMed
8. Int J Med Educ. 2018 Feb 09;9:35-41 - PubMed
9. West J Emerg Med. 2017 Jan;18(1):4-7 - PubMed
10. N Engl J Med. 2006 Nov 23;355(21):2217-25 - PubMed
11. BMC Med Educ. 2017 Aug 29;17(1):147 - PubMed
12. Med Educ. 2002 Aug;36(8):760-6 - PubMed
13. Am J Med Sci. 2015 Jul;350(1):64-7 - PubMed
14. Acad Med. 2000 Oct;75(10 Suppl):S127-35 - PubMed
15. Perspect Med Educ. 2016 Jun;5(3):147-53 - PubMed
16. Acad Med. 1990 Oct;65(10):611-21 - PubMed
17. Med Educ. 2012 Dec;46(12):1174-8 - PubMed
18. Acad Med. 2017 Jan;92(1):23-30 - PubMed
19. J Biomed Inform. 2005 Apr;38(2):154-71 - PubMed
20. Acad Med. 2016 Jul;91(7):1022-8 - PubMed
21. Acad Med. 1996 Oct;71(10 Suppl):S55-61 - PubMed
22. J Vet Med Educ. 2003 Fall;30(3):230-5 - PubMed
23. Med Educ Online. 2011 Mar 14;16: - PubMed

Publication Types

• Journal Article