Perspective 1: Critical Thinking and Clinical Reasoning
Dr. Noreen C. Facione, University of California San Francisco, and Dr. Peter A. Facione, Measured Reasons LLC, USA
At every level from novice to expert, clinical judgment regarding diagnosis, treatment, and on-going evaluation of patient outcomes is a fundamentally complex reasoning process which is applied to problems characterized by a multiplicity of potentially varying parameters, and which consumes cognitive resources including time to think as it relies upon core critical thinking skills and habits of mind, integrating our two systems of decision-making, susceptible to the benefits and shortcomings of cognitive dominance structuring. How clinical reasoning is experienced, even by the expert, is not a reliable measure of either the complexity or the quality of reasoning process. We would make an analogy to the practiced use of customized software on a computer. The apparent ease of the experience belies the cognitive, physiological and mechanical processes at work. We cannot make this point strongly enough, because the potential implications of overconfidence in one’s expertise in clinical reasoning could not be more grave for the sick and dying. Previously we were overly confident that students and novice clinicians would somehow “naturally” advance in their clinical reasoning as they were introduced to typical clinical case scenarios. But we have learned that without a direct focus on the critical thinking processes used to interpret, analyze, infer, evaluate, and explain what is going on, progress in clinical reasoning is an uncertain outcome.