Advanced practice: critical thinking and clinical reasoning
Clinical reasoning is a multi-faceted and complex construct, the understanding of which has emerged from multiple fields outside of healthcare literature, primarily the psychological and behavioural sciences. The application of clinical reasoning is central to the advanced non-medical practitioner (ANMP) role, as complex patient caseloads with undifferentiated and undiagnosed diseases are now a regular feature in healthcare practice. This article explores some of the key concepts and terminology that have evolved over the last four decades and have led to our modern day understanding of this topic. It also considers how clinical reasoning is vital for improving evidence-based diagnosis and subsequent effective care planning. A comprehensive guide to applying diagnostic reasoning on a body systems basis will be explored later in this series.
The Multi-professional Framework for Advanced Clinical Practice highlights clinical reasoning as one of the core clinical capabilities for advanced clinical practice in England (Health Education England (HEE), 2017). This is also identified in other specialist core capability frameworks and training syllabuses for advanced clinical practitioner (ACP) roles (Faculty of Intensive Care Medicine, 2018; Royal College of Emergency Medicine, 2019; HEE, 2020; HEE et al, 2020).
Rencic et al (2020) defined clinical reasoning as ‘a complex ability, requiring both declarative and procedural knowledge, such as physical examination and communication skills’. A plethora of literature exists surrounding this topic, with a recent systematic review identifying 625 papers, spanning 47 years, across the health professions (Young et al, 2020). A diverse range of terms are used to refer to clinical reasoning within the healthcare literature (Table 1), which can make defining their influence on their use within the clinical practice and educational arenas somewhat challenging.
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