ABSTRACT
INTRODUCTION: Emergency medicine (EM) has a high case turnover and acuity making it a demanding clinical reasoning domain especially for junior doctors who lack experience. We aimed to better understand their clinical reasoning using dual cognition as a guiding theory. METHODS: EM junior doctors were recruited from six hospitals in the south of England to participate in semi-structured interviews (n=20) and focus groups (n=17) based on recall of two recent cases. Transcripts were analysed using a grounded theory approach to identify themes and to develop a model of junior doctors' clinical reasoning in EM. RESULTS: Within cases, clinical reasoning occurred in three phases. In phase 1 (case framing), initial case cues and first impressions were predominantly intuitive, but checked by analytical thought and determined the urgency of clinical assessment. In phase 2 (evolving reasoning), non-analytical single cue and pattern recognitions were common which were subsequently validated by specific analytical strategies such as use of red flags. In phase 3 (ongoing uncertainty) analytical self-monitoring and reassurance strategies were used to precipitate a decision regarding discharge. CONCLUSION: We found a constant dialectic between intuitive and analytical cognition throughout the reasoning process. Our model of clinical reasoning by EM junior doctors illustrates the specific contextual manifestations of the dual cognition theory. Distinct diagnostic strategies are identified and together these give EM learners and educators a framework and vocabulary for discussion and learning about clinical reasoning.
Subject(s)
Emergency Medicine/education , Medical Staff, Hospital/psychology , Thinking , Adult , Decision Making , England , Female , Focus Groups , Grounded Theory , Humans , Internship and Residency , Interviews as Topic , MaleABSTRACT
This study aimed to define the profile of asthmatic children in Bahrain and the prevalence of sensitization to aeroallergens and foods. A total of 95 children who were clinically diagnosed with asthma were enrolled: 71.6% mild, 20.0% moderate and 8.4% severe asthma (NIH criteria). Serum IgE concentrations were elevated (> 200 kU/L) in 21.1% of patients and highly elevated (> 400 kU/L) in 9.5%. Absolute eosinophil counts were elevated (> 350 × 106/L) in 54.8%. Overall, 67.4% of children were atopic; 56.8% were sensitive to inhalant allergens and 39.0% to foods. The atopic profile was generally similar to asthmatic children in the region and worldwide. Conditions significantly associated with atopic asthma included food allergies, allergic rhinitis and eczema.
ABSTRACT
This study aimed to define the profile of asthmatic children in Bahrain and the prevalence of sensitization to aeroallergens and foods. A total of 95 children who were clinically diagnosed with asthma were enrolled: 71.6% mild, 20.0% moderate and 8.4% severe asthma [NIH criteria] Serum IgE concentrations were elevated [> 200 kU/L] in 21.1% of patients and highly elevated [> 400 kU/L] in 9.5%. Absolute eosinophil counts were elevated [>350 X 10[6]/L] in 54.8%. Overall, 67.4% of children were atopic; 56.8% were sensitive to inhalant allergens and 39.0% to foods. The atopic profile was generally similar to asthmatic children in the region and worldwide. Conditions significantly associated with atopic asthma included food allergies, allergic rhinitis and eczema
