Assessment of Reasoning Tool (ART) and Diagnostic Thinking

Overview

• The module focuses on assessing a learner's ability to think about their diagnostic thinking process using the Assessment of Reasoning tool (ART).
• Metacognition: The ability to think about one's own thinking process, crucial in recognizing tendencies in diagnostic reasoning.

Heuristics and Biases

• Heuristics: Tendencies in human thinking for efficient decision-making.
• Biases: Can lead to diagnostic errors.
• Anchoring: A tendency to fixate on specific initial findings and ignore contradictory subsequent information.
  • Example: Clinician fixates on peptic ulcer disease for epigastric pain and overlooks coronary artery disease despite exercise-induced pain.

Factors Affecting Diagnostic Thinking

• Fatigue and Stress: Can degrade decision-making quality.
  • Examples include sleep deprivation, distraction, or stress.

Using ART for Metacognition

• Case Study Example: Ms. Laura Thomas, a 27-year-old woman with symptoms of fatigue, sore throat, nasal congestion, and rhinorrhea.
  • Resident prescribes antibiotics for acute bacterial sinusitis based on past patient interactions, potentially influenced by emotional factors.

Evaluating Metacognitive Ability

• High Performer: Recognizes personal emotional influence on decision-making.
  • Learner reflects on personal connection to the patient and the influence on their judgment.
  • Marked as "Complete" on ART.
• Minimal Awareness: Learner unaware of emotional influences.
  • Marked as "Minimal" on ART.

Facilitating Metacognition

• Clinician's Role: Ask learners to consider situational or emotional influences on their diagnostic process.
  • Encourage thinking about different scenarios (e.g., new patient, no antibiotics request).
  • Aim to separate clinical data from emotional influences and improve future decision-making.

Conclusion

• Diagnostic thinking may be influenced by cognitive tendencies, situational, and emotional factors.
• Metacognition helps recognize these tendencies and offers a chance to improve clinical decision-making.