Management Reasoning: Empirical Determination of Key Features and a Conceptual Model - PubMed
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. 2023 Jan 1;98(1):80-87.
doi: 10.1097/ACM.0000000000004810.
Epub 2022 Dec 22.
Management Reasoning: Empirical Determination of Key Features and a Conceptual Model
David A Cook 
1
, Christopher R Stephenson 
2
, Larry D Gruppen 
3
, Steven J Durning 
4
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1 D.A. Cook is professor of medicine and professor of medical education, director of education science, Office of Applied Scholarship and Education Science, and consultant, Division of General Internal Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota; ORCID: https://orcid.org/0000-0003-2383-4633 .
2 C.R. Stephenson is assistant professor of medicine and consultant, Division of General Internal Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota; ORCID: https://orcid.org/0000-0001-8537-392X .
3 L.D. Gruppen is professor, Department of Learning Health Sciences, and director, Master in Health Professions Education Program, University of Michigan, Ann Arbor, Michigan; ORCID: https://orcid.org/0000-0002-2107-0126 .
4 S.J. Durning is professor and vice chair, Department of Medicine, and director, Center for Health Professions Education, Uniformed Services University of the Health Sciences, Bethesda, Maryland; ORCID: https://orcid.org/0000-0001-5223-1597 .
PMID:
35830267
DOI:
10.1097/ACM.0000000000004810
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Management Reasoning: Empirical Determination of Key Features and a Conceptual Model
David A Cook et al.
Acad Med.
2023.
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. 2023 Jan 1;98(1):80-87.
doi: 10.1097/ACM.0000000000004810.
Epub 2022 Dec 22.
Authors
David A Cook 
1
, Christopher R Stephenson 
2
, Larry D Gruppen 
3
, Steven J Durning 
4
Affiliations
1 D.A. Cook is professor of medicine and professor of medical education, director of education science, Office of Applied Scholarship and Education Science, and consultant, Division of General Internal Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota; ORCID: https://orcid.org/0000-0003-2383-4633 .
2 C.R. Stephenson is assistant professor of medicine and consultant, Division of General Internal Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota; ORCID: https://orcid.org/0000-0001-8537-392X .
3 L.D. Gruppen is professor, Department of Learning Health Sciences, and director, Master in Health Professions Education Program, University of Michigan, Ann Arbor, Michigan; ORCID: https://orcid.org/0000-0002-2107-0126 .
4 S.J. Durning is professor and vice chair, Department of Medicine, and director, Center for Health Professions Education, Uniformed Services University of the Health Sciences, Bethesda, Maryland; ORCID: https://orcid.org/0000-0001-5223-1597 .
PMID:
35830267
DOI:
10.1097/ACM.0000000000004810
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Abstract
Purpose:
Management reasoning is a critical yet understudied phenomenon in clinical practice and medical education. The authors sought to empirically identify key features of management reasoning and construct a model describing the management reasoning process.
Method:
In November 2020, 4 investigators each reviewed 10 video clips of simulated outpatient physician-patient encounters and used a coding form to document key features and insights related to management reasoning. The team used a constant comparative approach to distill 120 pages of raw observations into an 18-page list of management tasks, processes, and insights. The team then had a series of discussions to iteratively refine these findings into a parsimonious model of management reasoning.
Results:
The investigators empirically identified 12 distinct features of management reasoning: contrasting and selection among multiple solutions; prioritization of patient, clinician, and system preferences and constraints; communication and shared decision making; ongoing monitoring and adjustment of the management plan; dynamic interplay among people, systems, and competing priorities; illness-specific knowledge; process knowledge; management scripts; clinician roles as patient teacher and salesperson; clinician-patient relationship; prognostication; and organization of the clinical encounter (sequencing and time management). Management scripts seemed to play a prominent and critical role. The model of management reasoning comprised 4 steps: instantiation of a management script, identifying (multiple) options and beginning to teach the patient, shared decision making, and ongoing monitoring and adjustment. This model also conceives 2 overarching features: that management reasoning is personalized to the patient and that it occurs between individuals rather than exclusively within the clinician's mind.
Conclusions:
Management scripts constitute a key feature of management reasoning, along with teaching patients about viable options, shared decision making, ongoing monitoring and adjustment, and personalization. Management reasoning seems to be constructed and negotiated between individuals rather than exclusively within the clinician.
PubMed Disclaimer
Comment in
Management Reasoning: Using Scripts to Enhance Teaching.
Kaminski JJ, Peters H.
Kaminski JJ, et al.
Acad Med. 2024 Jan 1;99(1):11. doi: 10.1097/ACM.0000000000005487. Epub 2023 Oct 24.
Acad Med. 2024.
PMID: 37890088
No abstract available.
References
Cook DA, Durning SJ, Sherbino J, Gruppen LD. Management reasoning: Implications for health professions educators and a research agenda. Acad Med. 2019;94:1310–1316.
Cook DA, Sherbino J, Durning SJ. Management reasoning: Beyond the diagnosis. JAMA. 2018;319:2267–2268.
Norman G, Young M, Brooks L. Non-analytical models of clinical reasoning: The role of experience. Med Educ. 2007;41:1140–1145.
Elstein AS, Shulman LS, Sprafka SA. Medical Problem Solving: An Analysis of Clinical Reasoning. Cambridge, MA: Harvard University Press; 1978.
Eva KW, Norman GR. Heuristics and biases: A biased perspective on clinical reasoning. Med Educ. 2005;39:870–872.
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MeSH terms
Communication
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Decision Making, Shared
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Education, Medical*
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Humans
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