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 Table of Contents  
LETTER TO EDITOR
Year : 2022  |  Volume : 3  |  Issue : 3  |  Page : 301-302

Clinical reasoning: How to achieve a greater clinical effectiveness in neurotrauma?


1 Department of Neurosurgery, Holy Family Hospital, Dhaka, Bangladesh
2 Department of Research, Latinamerican Council of Neurocritical Care, Bogota; Department of Research, Colombian Clinical Research Group in Neurocritical Care, Cartagena, Colombia
3 Department of Research, Colombian Clinical Research Group in Neurocritical Care, Cartagena, Colombia; Department of Critical Care Medicine, Physician Regional Medical Center, Naples, Florida

Date of Submission17-Mar-2022
Date of Acceptance08-Sep-2022
Date of Web Publication28-Dec-2022

Correspondence Address:
Dr. Luis Rafael Moscote-Salazar
Latinamerican Council of Neurocritical Care (CLaNI), Bogota
Colombia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JME.JME_20_22

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How to cite this article:
Rahman MM, Moscote-Salazar LR, Janjua T, Agrawal A. Clinical reasoning: How to achieve a greater clinical effectiveness in neurotrauma?. J Med Evid 2022;3:301-2

How to cite this URL:
Rahman MM, Moscote-Salazar LR, Janjua T, Agrawal A. Clinical reasoning: How to achieve a greater clinical effectiveness in neurotrauma?. J Med Evid [serial online] 2022 [cited 2023 Feb 1];3:301-2. Available from: http://www.journaljme.org/text.asp?2022/3/3/301/365860



Just like any discipline of practice of medicine, clinical reasoning is a fundamental tool of the neurointensivist. Using the clinical methods with solid knowledge, clinical reasoning creates hypotheses and therapeutic strategies to improve the clinical condition of neurocritical patients. Neurocritical medicine faces the challenge of abundant and variable information, with diverse evidence. This can lead to the limitation of reaching timely and rapid decisions. Adequate clinical reasoning helps define clinical behaviours, which must go hand in hand with the clinical evidence.[1],[2] Clinical reasoning, being a concept that is not easy to transmit, is sometimes learnt from the oversight of experienced clinicians. For the novice, the need to have mentoring from more expert people is imperative. The complexity and heterogeneity of traumatic brain pathology require the concept of clinical reasoning to be incorporated into our clinical practice. The clinical horizon of neurotrauma from mild traumatic injury to severe cases where the incorporation of multimodal monitoring is required makes decision-making not an easy task. Training in neurointensive care requires exposure to a varied volume of cases that allows the trainee to incorporate situations associated with the various clinical courses of the same disease.

Among the strategies are all those that promote critical analysis including real-time access to the literature, among others. In this context, a clinical case presentation is a valuable tool to progressively improve clinical reasoning. [Figure 1] illustrates one proposed thought process on how to achieve a multimodal approach to clinical reasoning in neurocritical care and neurotrauma. The task is to recognise that a process is in place to achieve an adequate level of clinical reasoning at the end of training. To get that the task is to put the process in place, review the potential issues and all key players buy into the process. There is an agreement followed by the initiation of the process. The assignment of case presentations, journal clubs, concise projects, multidisciplinary discussions and publications are reviewed by an oversight process. Once the assignment is given, ample time is given for discussions and preparation. A senior clinician review before the presentation, submission for peer review, etc., is prudent for this process to succeed. There should be robust access to published studies.
Figure 1: Clinical reasoning training in neurocritical care

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The clinical effectiveness of neurotrauma patients depends on various factors such as pre-hospital management, hospital treatment, rehabilitation and evidence-based practice for TBI patients. A mnemonic for recalling the neuroanatomic location of circuits affected in the most frequent cognitive and other neuropsychiatric symptoms following traumatic brain injury was described in a study.[3] They suggested remembering descriptions of these syndromes using Quinn and Katzman's “Wizard of Oz” technique.[4] Any physician treating patients should be familiar with these disorders and the circuits that govern them. The student, teacher, context and material all have a part in the approaches used to teach clinical reasoning.[5] According to a study, occupational therapists and neuropsychologists utilised clinical reasoning to classify performance errors produced by people with acquired brain injury or healthy controls during an ecological performance-based assessment of executive functioning.[6] Ark et al. found that a combined reasoning approach yields the best results, and they recommend that training revolves around many examples to help novice clinicians develop a repertoire of cases to support pattern recognition, as well as explicitly empowering dual processing by teaching the necessary knowledge to analyse complex cases.[7] It is important to note that clinical competencies do not improve even though more experience is acquired; on the contrary, they remain stable or decrease over time.[8] In conclusion, clinical reasoning is a basic element for young clinicians to reach a level where patient care is done under the full auspices of evidence-based medicine in a timely manner.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Rodríguez de Castro F, Carrillo-Díaz T, Freixinet Gilart J, Julià-Serdà G. Razonamiento clínico. FEM Rev Fundación Educ Méd 2017;20:149-60.  Back to cited text no. 1
    
2.
Connors GR, Siner JM. Clinical reasoning and risk in the Intensive Care Unit. Clin Chest Med 2015;36:449-59.  Back to cited text no. 2
    
3.
Peters ME, Moussawi K, Rao V. Teaching clinical reasoning with an example mnemonic for the neuropsychiatric syndromes of traumatic brain injury. Acad Psychiatry 2018;42:686-9.  Back to cited text no. 3
    
4.
Quinn D, Katzman J. “The Wizard of Oz:” A depiction of TBI-related neurobehavioral syndromes. Acad Psychiatry 2012;36:340-4.  Back to cited text no. 4
    
5.
Gooding HC, Mann K, Armstrong E. Twelve tips for applying the science of learning to health professions education. Med Teach 2017;39:26-31.  Back to cited text no. 5
    
6.
Bottari C, Iliopoulos G, Wai Shun PL, Dawson DR. The clinical reasoning that guides therapists in interpreting errors in real-world performance. J Head Trauma Rehabil 2014;29:E18-30.  Back to cited text no. 6
    
7.
Ark TK, Brooks LR, Eva KW. Giving learners the best of both worlds: Do clinical teachers need to guard against teaching pattern recognition to novices? Acad Med 2006;81:405-9.  Back to cited text no. 7
    
8.
Choudhry NK, Fletcher RH, Soumerai SB. Systematic review: The relationship between clinical experience and quality of health care. Ann Intern Med 2005;142:260-73.  Back to cited text no. 8
    


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