Exploring procedure-based management reasoning: a case of tension pneumothorax
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Raj C. Singaraju
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Steven J. Durning
Abstract
Objectives
Management reasoning has not been widely explored but likely requires broader abilities than diagnostic reasoning. An enhanced understanding of management reasoning could improve medical education and patient care. We conducted a novel exploratory study to gain further insights into procedure-based management reasoning.
Methods
Participant physicians managed a simulated patient who acutely decompensates in a team-based, time-pressured, live scenario. Immediately following the scenario, physicians perform a think-aloud protocol by watching video recordings of their performance and narrating their reflections in real-time. Verbatim transcripts of the think-aloud protocol were inductively coded using a constant comparative method and evaluated for themes.
Results
We recruited 19 physicians (15 internal medicine, one family medicine, and three general surgery) for this study. Recognizing that diagnostic and management reasoning intertwine, this paper focuses on management reasoning’s characteristics. We developed three categories of management reasoning factors with eight subthemes. These are Patient factors: Acuity and Preferences; Physician factors: Recognized Errors, Anxiety, Metacognition, Monitoring, and Threshold to Treat; and one Environment factor: Resources.
Conclusions
Our findings on procedure-based management reasoning are consistent with Situation Awareness and Situated Cognition models and the extant work on management reasoning, demonstrating that management is inherently complex and contextually bound. Unique to this study, all physicians focused on prognosis, indicating that attaining competency in procedural management may require planning and prediction abilities. Physicians also expressed concerns about making mistakes, potentially resulting from the scenario’s emphasis on a procedure and our physicians’ having less expertise in the treatment of tension pneumothorax.
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Research funding: None declared.
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Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
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Competing interests: Authors state no conflict of interest.
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Informed consent: Informed consent was obtained from all individuals included in this study.
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Ethical approval: The local Institutional Review Board approved this study.
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Disclaimer: The opinions and assertions expressed herein are those of the author(s) and do not necessarily reflect the official policy or position of the Uniformed Services University or the Department of Defense.
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© 2022 Walter de Gruyter GmbH, Berlin/Boston
Artikel in diesem Heft
- Frontmatter
- Review
- Diagnostic and therapeutic approach to hypernatremia
- Opinion Papers
- The diagnostic potential and barriers of microbiome based therapeutics
- Pursuit of “endpoint diagnoses” as a cognitive forcing strategy to avoid premature diagnostic closure
- Guidelines and Recommendations
- The e-Autopsy/e-Biopsy: a systematic chart review to increase safety and diagnostic accuracy
- Original Articles
- Exploring procedure-based management reasoning: a case of tension pneumothorax
- A structured approach to EHR surveillance of diagnostic error in acute care: an exploratory analysis of two institutionally-defined case cohorts
- Human centered design workshops as a meta-solution to diagnostic disparities
- Longitudinal clinical reasoning theme embedded across four years of a medical school curriculum
- Using the Assessment of Reasoning Tool to facilitate feedback about diagnostic reasoning
- Evolution of throat symptoms during the COVID-19 pandemic in the US
- Evaluating the role of a fully automated SARS-CoV-2 antigen ECLIA immunoassay in the management of the SARS COV 2 pandemic on general population
- miR-21-3p and miR-192-5p in patients with type 2 diabetic nephropathy
- Letter to the Editors
- Convoluted molecular maze of neprilysin
- OPeNet: an AI-based platform implemented to facilitate clinical reasoning by primary care practitioners, as well as the virtuous co-management of chronic patients during and after the COVID-19 pandemic in Italy
- Letter to the Editor in reply to Diamandis “COVID-19 and the Le Chatelier’s principle”
Artikel in diesem Heft
- Frontmatter
- Review
- Diagnostic and therapeutic approach to hypernatremia
- Opinion Papers
- The diagnostic potential and barriers of microbiome based therapeutics
- Pursuit of “endpoint diagnoses” as a cognitive forcing strategy to avoid premature diagnostic closure
- Guidelines and Recommendations
- The e-Autopsy/e-Biopsy: a systematic chart review to increase safety and diagnostic accuracy
- Original Articles
- Exploring procedure-based management reasoning: a case of tension pneumothorax
- A structured approach to EHR surveillance of diagnostic error in acute care: an exploratory analysis of two institutionally-defined case cohorts
- Human centered design workshops as a meta-solution to diagnostic disparities
- Longitudinal clinical reasoning theme embedded across four years of a medical school curriculum
- Using the Assessment of Reasoning Tool to facilitate feedback about diagnostic reasoning
- Evolution of throat symptoms during the COVID-19 pandemic in the US
- Evaluating the role of a fully automated SARS-CoV-2 antigen ECLIA immunoassay in the management of the SARS COV 2 pandemic on general population
- miR-21-3p and miR-192-5p in patients with type 2 diabetic nephropathy
- Letter to the Editors
- Convoluted molecular maze of neprilysin
- OPeNet: an AI-based platform implemented to facilitate clinical reasoning by primary care practitioners, as well as the virtuous co-management of chronic patients during and after the COVID-19 pandemic in Italy
- Letter to the Editor in reply to Diamandis “COVID-19 and the Le Chatelier’s principle”
