UN CADRE CONCEPTUEL POUR L’ÉLABORATION D’UN MODÈLE INTÉGRÉ DE DEVELOPPEMENT LA COMPÉTENCE DU RAISONNEMENT CLINIQUE DANS LES SCIENCES DE LA SANTE
Creators: name: Najat, Boulahna
Publisher: name: Moroccan Journal of Quantitative and Qualitative Research
Year: 2021
Subjects: clinical reasoning ,development ,expertise ,competency

description: A conceptual framework for the development of an integrated model for developing the competency of clinical reasoning in health sciences Abstract Clinical reasoning has attracted the interest of researchers in cognitive psychology and education sciences, knowing that it is a skill necessary for developing the clinical expertise of a health professional and solving health problems often described as complex, and that competence is the combination and mobilization of knowledge, skills (capabilities) and attitudes, it remains poorly defined in terms of components and indicators and therefore its evaluation and learning remains incomplete often focused on one or more components and rarely involving all the components, hence the interest of this bibliographical research in order to develop a conceptual framework for the development of a model incorporating all the components of clinical reasoning and their indicators thus facilitating its operationalization and thus enabling a targeted and effective global development of the clinical reasoning a literature review related to clinical reasoning allowed us to identify conceptual models that can meet our research objective is to identify the components of reasoning, their indicators, evaluation and development strategies, so we searched for secondary data in French and English by keywords: clinical reaosonning( , evaluation (assessment), teaching (teaching) difficulties error, remediation at the level of Google schollar between 2000 and 2019 to have a macroscopic view of the themes related to our research object, then a more in-depth search in databases (scopus, cairn, crossref and direct sciences) using the software publish or perish to spot the journals and newspapers that publish in the topic. The resources selected and collected to 215 were organized by the zotero software designed for the management of bibliography by types of resources (review, journal, thesis, book or book chapter, conference report, etc.). Then exported in a folder that is subsequently imported into the NVIVO software designed for the textual analysis of secondary and primary data, in which we proceeded to explore the abstracts of our resources in order to determine the empirical work on clinical reasoning , and then we proceeded to cross-reference them by database, by year of publication and by authors. , in addition to identifying the most frequent and less frequent words and their corresponding resources through what is called the word cloud The collection and organization of our library resources through the procedure described above as well as the characteristics of our resources according to databases, publication review, types of resources (article, theses, books or book chapters), library resources according to the year and authors allowed us to infer that clinical reasoning is concept that has developed mainly in the medical field so more than 50% of our library resources are derived from indexed scientific journals interested in pedagogy and education in the medical field.in addition we note a predominance of the work carried out in the Canadian and Anglo-Saxon context, this is argued by the interest of Canadian universities brought to this concept by the publication of theses and scientific articles mainly by Canadian authors (Bernard Charlin and Audetat Marie Claude ) then the textual research has allowed us to identify the most common words in our research that constitute the central themes related to clinical reasoning in particular, clinical reasoning, its definition, its cognitive and metacognitive processes or strategies, their relationship with diagnosis, professional performance, clinical expertise, explanatory factors of reasoning and its processes in particular; the organization of knowledge, experience, learning, evaluation, difficulties their nature and origin as well as strategies and approaches to remediation of them. Finally, the intersection of each theme with our library resources allowed us to develop a list of resources most relevant to each topic (see lists of attributes and their references), see Appendixes I and II thus this list of constructeds and their reference allowed us to deduce that the competence of clinical reasoning is composed of cognitive abilities (reformulation, synthesis, hypothesis generation, analysis, judgment, argumentation, comparison ect and metacognitive abilities (metacognitive knowledge: knowledge of what, when, why and how of cognition and regulatory skills (planning, monitoring, communication skills and relationships . The expertise in clinical reasoning depends on a number of factors raised by the literature, namely an organization of knowledge developed in the form of (semantic networks, concrete cases, instances, prototypes or scripts), a consequence of all the connections and links established between concepts and/or lived experiences ,In addition to the context that is defined as an integral part of the situation to be managed by the clinician, it involves actors (patient, clinician, care setting), and finally it also depends on experience, so an advanced experience of a clinician orientates it to a not analytical process based on the recognition of forms and similarities. On top of that The manner clinical experience is stocked in memory makes easier or hinders the capacity to formulate the presentation of problem, in other words The expert clinicians stock and remember knowledge as diseases, conditions or syndromes - « scripts of illness » - which are linked to the presentation of problem (Bowen, on 2006). Therefore the development of expertise in clinical reasoning is dependent on several mailmen (organization of knowledge, experience, context, memory, métacognition, alternation of not analytical and analytical processes). The evaluation of clinical reasoning is done by different methods and tools developed in a clinical context using the technique of verbalization of reasoning aloud or direct observation guided by grids (Charlin et al., 2003) and others developed in a preclinical setting using vignettes or scenarios of real cases simulated by the written word generally evaluating either of the skills related to the clinic in particular; knowledge organization, interpretation and analysis or hypothesis generation, hence the interest of combining several tools whose match script tests are currently considered to be the most relevant by its highly qualified psychometric qualities and its ability to assess the set of cognitive skills related to clinical reasoning. the development and support of clinical reasoning can be done in a clinical context through log book-associated reflexive practice workshops and questioning strategies, supervisory methods (SNAPS, supervisor's minute, reverse supervision method or The Aunt Minnie method combined with explanation, reading and schematics) and cognitive function strategies (debriefing) ,echaffaudage, scafaulding) ,However in the preclinical context problem learning, case-based clinical reasoning, associated with conceptual and procedural maps, simulation and matching of scripts can be very relevant methods for the development of clinical reasoning competence. in conclusion Clinical reasoning is a complex and multidimensional skill involving several cognitive abilities, attitudes and communication and relational skills, in addition to developing expertise in this skill depends on several factors, methods and strategies that can be applied in clinical and preclinical context for its development, support as well as tools and methods for evaluating its processes and outcomes.
description: Moroccan Journal of Quantitative and Qualitative Research, Vol. 2, No 3 (2020)