This paper describes a model of the clinical process in psychiatry. Research into the clinical reasoning of physicians is reviewed. Experimental work at the University of Vermont has demonstrated systematic differences between medical students and psychiatrists of different levels of experience, in regard to the logical order and complexity of clinical reasoning. A psychiatric educational program which objectifies cue recognition, clinical inference, hypothesis generation and systematic enquiry has been associated with changes in reasoning. This suggests that the acquisition of efficient diagnostic reasoning strategies could be accelerated by appropriately designed educational programs.
References
1.
BarrowsH.S. (1979) An overview of medical problem solving. Paper delivered to the conference on The Role of Problem Solving in Medicine at Smugglers' Notch, Vermont. University of Vermont Office of Continuing Medical Education, Burlington, Vermont.
2.
BerelsonB. (1952) Content Analysis in Communication Research.Free Press, New York.
3.
BerelsonB. (1954) Content Analysis. In Handbook of Social PsychologyVolume I (edited by LindzeyG.). Addison Wesley, Cambridge, Mass.
4.
BrainerdC. J. (1978) Piaget's Theory of Intelligence.Prentice Hall, New Jersey.
5.
ElsteinA. S.ShulmanL. S.SprafkaS. A. (1978) Medical Problem Solving: An Analysis of Clinical Reasoning.Harvard University, Cambridge, Mass.
6.
FeightnerJ. W.NormanG. R.BarrowsH. S.NeufeldV. R. (1975) A comparison of the clinical methods of primary and secondary care physicians. Paper delivered to a symposium sponsored by the Association of American Medical Colleges, Washington, D.C.
7.
FeinsteinA. R. (1967) Clinical Judgement.Williams and Wilkins, Baltimore.
8.
FeinsteinA. R. (1974) An analysis of clinical reasoning. II The strategy of intermediate decisions. Yale Journal of Biology and Medicine, 46, 264–283.
9.
Fitzhenry-CoorI. (1978) Developmental social cognitive processes in the clinical interview: a model. Paper presented at the annual meeting of the American Psychological Association, Toronto.
10.
Fitzhenry-CoorI.NurcombeB. (1979) The Vermont diagnostic process research project II: methodology. Paper delivered to the conference on The Role of Problem Solving in Medicine at Smugglers' Notch, Vermont, Burlington, Vermont: University of Vermont Office of Continuing Medical Education.
11.
FlapanD. (1968) Children's Understanding of Social Interaction.Teachers' College Press, New York.
12.
FreudS. (1923) The ego and the id. In (StracheyJ., ed.) Standard Edition, 19, 12–66, 1951, Hogarth, London.
13.
GagneR. W. (1980) Learnable aspects of problem solving. Educational Psychologist, 15, 84–90.
14.
GauronE. F.DickinsonJ. K. (1965) Diagnostic decision-making in psychiatry. I Information usage. II Diagnostic styles. Archives of General Psychiatry, 14, 225–232 and 233–237.
15.
InhelderB.PiagetJ. (1958) The Growth of Logical Thinking from Childhood to Adolescence.Basic Books, New York.
16.
LivesleyN. J.BromleyD. B. (1973) Person Perception in Childhood and Adolescence.John Wiley, New York.
17.
LoevingerJ.WaslerR.RedmoreC. (1970) Measuring Ego Development. Volumes I & II. Jossey-Bass, San Francisco.
18.
LoevingerJ. (1976) Ego Development.Jossey-Bass, San Francisco.
19.
NurcombeB.Fitzhenry-CoorI. (1979) The Vermont diagnostic process research project I: rationale and aims. Paper delivered to the conference on The Role of Problem Solving in Medicine at Smugglers' Notch, Vermont, Burlington, Vermont: University of Vermont Office of Continuing Medical Education.
20.
PerryW. G. (1968) Forms of Intellectual and Ethical Development in the College Years.Holt, Rinehart and Winston, New York.
21.
RothsteinE. (1980) The scar of Sigmund Freud. New York Review of Books, 27, 14–20.
22.
ShraugerS. (1967) Cognitive differentiation and the impression formation process. Journal of Personality, 35, 402–414.
23.
SiegelS. (1956) Non-parametric Statistics for the Behavioural Sciences.McGraw-Hill, New York.
24.
WeedL. L. (1975) Your Health Care and How to Manage It.Essex Junction, Vermont: Essex Publishing Company, Inc.
