Clinical reasoning is an essential competence of veterinary graduands. Unfortunately, clinical reasoning and, therefore, the quality of provided veterinary medical services are prone to bias, difficulties, and errors. The literature on biases, difficulties, and errors in clinical reasoning in veterinary medical education is scarce or focused on theoretical rather than practical application. In this review, we address the practicality of learning and teaching biases, difficulties, and errors in clinical reasoning to veterinary learners utilizing a practical example of a cow with a prolapsed uterus complicated by hypocalcemia and hypomagnesemia. Learners should be guided through all of the stages of clinical reasoning as much as possible under direct supervision. The common clinical biases, difficulties, or errors in veterinary medical encounters may differ between stages of development of the learner, with more difficulties occurring in earlier stages (Observer, Reporter, ±Interpreter) but more heuristic biases occurring at later stages (Manager, Educator, ±Interpreter). However, clinical errors may occur at any learner development stage. Therefore, remediation of clinical biases, difficulties, and errors in veterinary medical encounters should use strategies that are tailored to the level of development of the learner, but also to the specific encounter (e.g., client, patient, and context).
Client ± Patient-Related | Cognition-Related | Process-Related | System-Related |
---|---|---|---|
Challenging learners/practitioner’s credentials [19][33][34][19,33,34] Client’s ± patient’s characteristics [4][19][20][34][35][36][37][38][4,19,20,34,35,36,37,38] Client’s wish/es and perceptions [34][38][39][34,38,39] Incorrect hypothesis suggestions [19][33][39][40][19,33,39,40] Language and vocabulary [19] Understanding of the problem [34][40][34,40] |
Awareness of common clinical reasoning biases, difficulties, or errors [9][11][12][16][17][20][21][41][42][43][44][45][46][47][48][49][50][9,11,12,16,17,20,21,41,42,43,44,45,46,47,48,49,50] Awareness of bias, difficulty, or error in clinical reasoning remediation strategies [9][11][12][16][,12],1617][20][21][41][42][,17[,2043][44][45][4647],21[48],41[49],42[,4350,44][51][9,11,45,46,47,48,49,50,51] Breadth and depth of veterinary medical cognition [12][32][52][53][12,32,52,53] Expertise/level of development [7][19][21][53][54][7,19,21,53,54] Metacognitive competences Organization of mental representation [16][55][16,55] Personal attitude (e.g., beliefs, confidence, contemplation, creativity, curiosity, flexibility, inquisitiveness, intellectual integrity, intuition, motivation, open-mindedness, perseverance, prejudices, and values) [2][4][34][36][38][56][57][2,4,34,36,38,56,57] Personal psychomotor state (e.g., fatigue, sleep deprivation, and stress) [2][4][19][20][34][35],34[40],35[51],40[57],51[58],57[59][2,4,19,20,58,59] |
Available versus required time for the encounter [2][4][19][20][57][2,4,19,20,57] Depth and level of supervision [50][51][60][50,51,60] Error management Individual versus teamwork Method of clinical teaching [9][50][61][62][9,50,61,62] Reflection [16][63][64][16,63,64] |
Available resources [2][19][[39][220][35],19,20,35,39] Available versus required time for the encounter [2][4][19][20][57][2,4,19,20,57] Client-learner/practitioner relationship [33][34][38][40][33,34,38,40] Clinical encounter (e.g., urgency) [34][35][34,35] Clinical settings [35][36][39][65][35,36,39,65] Communication skills [33][34][39][40][42][66][67][33,34,39,40,42,66,67] Cultural environment [39] Distractors (e.g., noise) [4][35][57][4,35,57] Environment [34][57][34,57] Ethical issues [35][39][35,39] Financial constraints [2][39][2,39] Frequency of encounter Group/team size Industry-related factors and issues [39] Legal factors and issues [39] Level of complexity Level of supervision [50][60][62][50,60,62] Social environment [1][2][5][19][20][58][64][68][69][70][71][72][1,2,5,19,20,58,64,68,69,70,71,72] Support from the team [20][50][20,50] Team dynamics [57] |