Developing Clinical Reasoning to Tackle the KFP
As a GP, we are undertaking clinical reasoning with nearly every patient. It is most often automatic. However, in preparation for the KFP exam, it can be helpful to deconstruct the clinical reasoning process. The ultimate goal, however, is to make us better clinicians, not just to pass the exam!
A definition of clinical reasoning includes an ability to integrate and apply knowledge, to weigh evidence, critically think about arguments and to reflect upon the process used to arrive at a diagnosis. We learn this at the bedside of our consultants and supervisors. It implies that we have a good knowledge of
Dual Process Theory
It is important to know about Dual Process Theory when we are talking about Clinical Reasoning. As medical students, we are taught Type 2 thinking – this is a slow, methodical, logical process driven type of thinking, where we are taught to take a history from the patient, formulate differential diagnoses, and rule those differentials in or out by further history, physical examination and investigations. Type 1 thinking is intuitive, fast, automatic and experiential. This is developed as you become more experienced.
A good clinical thinker routinely approaches a clinical presentation by using a combination of Type 1 and Type 2 thinking. The nonanalytic approach is more common, accounting for 80% of clinical reasoning and is based on pattern (or illness script) recognition(2).
Preparing for the KFP
When preparing for the KFP, be aware of which type of thinking you are using. It is important to see as many patients as possible in the lead up to the
Any history questions, physical examination
There are several good resources to help improve your clinical reasoning.
- Being aware of Diagnostic error is important. This article on Life in the Fastlane is helpful.
- IM Reasoning Podcast is helpful, particularly the “Stump the Chumps” Episodes. If you do a lot of driving or walking, these podcasts are invaluable. Can be downloaded from App store, or found at IM Reasoning
- An AFP article on learning Clinical Reasoning
- The Society to Improve Diagnosis in Medicine has a website, which has a Clinical Reasoning Toolkit, with several resources. If you are interested in reading more about this area, I suggest that you look at this.
Dr Allison Miller
Allison is a GP with over 20 years experience. She is a Medical Educator (ME) for a GP Training Provider and has been an OSCE examiner with the RACGP since 2010. Allison is one of the expert MEs that co-facilitate the Medcast exam preparation courses.
The latest healthcare news from medcast
On being a GP seeking help
I had an interesting experience at my GP recently. I don’t go to the GP very often. Mostly I don’t get sick. Sometimes I treat my own ills or just soldier on. On the few occasions that I have been to see someone about something concerning me, my overwhelming experience has been of being judged and dismissed. I feel that they think that, as a doctor, I should have not only made the diagnosis but also treated myself. In fact, I should have been better way before I thought to come along!
Let’s talk about self-soothing
I talk to a lot of health professionals and it amazes me how often people look at me blankly when I introduce the subject of self-soothing activities. As the conversation progresses I can see most of the blank looks turn to some degree of understanding as they begin to acknowledge the familiarity of the concept in their own lives, but GPs in particular are not generally familiar with the fact that teaching people about emotional management strategies is a core part of therapy, and an intervention that is entirely available to them in general practice.
Can I have medical cannabis on PBS doctor?
I’ve been asked this question twice in the last month. Once by a 70 year old patient who has taken up smoking weed to control her neuropathic pain, let’s call her ‘Rachel’. And the other a young man aged 26 (Sean) who is smoking cannabis to help control his chronic anxiety.