Developing Clinical Reasoning to Tackle the KFP

As a GP, we are undertaking clinical reasoning with nearly every patient that we see. 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!
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 medicine, and the conditions that we encounter. We should have an “illness script” for each condition, so that we can compare it to the bank of other conditions in our illness script “filing cabinet” (pattern recognition).

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 exam, and use them to practice your clinical reasoning. Practice your Type 2 Reasoning, and use Murtagh’s PROMPT as a framework to do this.

Any history questions, physical examination and investigations should be targeted at ruling in and ruling out your differentials and red flags. The 'Masquerades' and 'Often Missed' should be thought of, and investigated if appropriate.

There are several good resources to help improve your clinical reasoning.

  1. Being aware of Diagnostic error is important. This article on Life in the Fastlane is helpful. 
  2. 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
  3. An AFP article on learning Clinical Reasoning
  4. 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.

Medcast Exam Preparation Courses

Did you know that Medcast now offers an intensive 15-week exam preparation course? Our Boot Camp is an interactive small group course where you will be mentored by highly experienced medical educators, get feedback on your performance, review exam questions and ideal answers, and discuss strategies and exam technique. Click here to find out more.

{{commentCount}} comment(s). You must be logged in and AHPRA verified to view and comment. LOG IN

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

Preoperative Assessment and Mallampati Scores
Preoperative Assessment and Mallampati Scores

The Mallampati Score or Classification is a simple and easy to use tool that assists in predicting difficult endotracheal intubation.

Better Together: GP Supervisor Education
Better Together: GP Supervisor Education

Q: What do fish and chips, Batman and Robin, and country and western music have in common?

2020, a year in review: Dr Carol Newall
2020, a year in review: Dr Carol Newall

We've asked some Community of Practice members to tell us about what 2020 has meant to them. Some things may surprise you...

2020, a year in review: Dr Genevieve Yates
2020, a year in review: Dr Genevieve Yates

We've asked some Community of Practice members to tell us about what 2020 has meant to them. Some things may surprise you...

Long COVID-19
Long COVID-19

Do we really need another syndrome?! Isn’t it just the same as recovery from any other infectious disease?

Keys to prevention in mental health - Alexithymia
Keys to prevention in mental health - Alexithymia

I first encountered the concept of alexithymia when I worked with people suffering from eating disorders. Many people experiencing eating disorders have great difficulty identifying and naming their own emotions.

Adult Basic Life Support during COVID-19
Adult Basic Life Support during COVID-19

Many healthcare processes have been re-evaluated in light of the current COVID-19 pandemic.

Who benefits from eMental Health?
Who benefits from eMental Health?

The answer to that question definitely depends on who you ask. Let’s start with the cynics and get them out of the way.

Fight back. Never yield: Atrial Fibrillation
Fight back. Never yield: Atrial Fibrillation

This is no time to yield to atrial fibrillation (AF). As a former clinical pharmacist and academic working in the internal medicine ward and ambulatory clinic of a busy teaching hospital in Ethiopia, I encountered numerous cases where patients suf...

KISS Guide to Evidence Based Medicine 2020
KISS Guide to Evidence Based Medicine 2020

This Hot Topics Keep it Simple Summary is a guide to evidence based medicine in 2020, straight from our UK partners, NB Medical.

A tree change is in the wind
A tree change is in the wind

Change seems to be the theme of 2020. In our region, as with many in Australia, it started with bushfires, before a jump to the left into ‘COVID Capers’.

Writing your COVID worries away - (with Andrew Gan and Dr Jet)
Writing your COVID worries away - (with Andrew Gan and Dr Jet)

COVID and all its attendant inconveniences (I guess some would say “tortures”) has forced many of us to revise our personal wellbeing plans and dig out some old strategies that we haven’t used for a while. It’s also made some of us realise that ma...

Malignant Hyperthermia
Malignant Hyperthermia

Malignant Hyperthermia is a rare and potentially life threatening genetically inherited condition that can be triggered by drugs commonly used in anaesthesia. If it is not recognised and treated in its early stages, MH can be fatal.

Restless Leg Syndrome - Podcast
Restless Leg Syndrome - Podcast

Restless leg syndrome is a common presentation in General Practice characterised by uncomfortable sensations in the legs. These sensations are associated with an irresistible urge to move the legs to relieve the symptoms.

Telehealth Fatigue
Telehealth Fatigue

My patients are loving telehealth. They love it so much that most of them are saying they don’t want to come back to face to face consultations. You probably need to bear in mind that my patients are long-term therapy patients that I know very well.

Paediatric Advanced Life Support Standards
Paediatric Advanced Life Support Standards

In order to achieve these standards, it is essential that medical and nursing staff who work with paediatric patients receive specialised education to manage a paediatric cardiopulmonary arrest.

Would learning something new wash your Acedia away?
Would learning something new wash your Acedia away?

Is Acadia running your life right now? Are you, like the solitary monks who used that term in the middle ages, suffering from the combination of boredom, frustration, agitation and lethargy that comes with physical isolation?

COVID conspiracies – should we ignore them?
COVID conspiracies – should we ignore them?

Like me, you probably spend a lot of time talking to people about how they feel about the COVID 19 pandemic, but do you talk to them about their thoughts and beliefs about it?

Medication Spotlight: Paracetamol
Medication Spotlight: Paracetamol

A frequently used medication in community and hospital settings is paracetamol (named acetaminophen in some countries). It has less adverse effects than other analgesics, as it has no effect on platelet functioning and allergies are very rare.

Helping prevent suicide among Australia's Indigenous Youth
Helping prevent suicide among Australia's Indigenous Youth

Suicide in Australia amongst Aboriginal and Torres Strait Islander peoples occur at twice the rate of the general population. Young Aboriginal and Torres Strait Islander people are at even greater risk, those aged 5 to 17 years, suicide is the le...

Join Medcast. It's free and you'll get instant access to essential healthcare news, research and more.

Already a member? Log In