Clinical Reasoning Form THROWNDOWN

[Scott Resetar]

Two clinical reasoning forms enter, one clinical reasoning form leaves.

In this month’s PTJ, the Army-Baylor group published a cool case report using their clinical reasoning form, which they state “To our knowledge, the only clinical reasoning tool published in the peer reviewed literature is used in a pediatric
residency.” They note other reasoning forms exist in textbooks but are lengthy.

So, let’s compare and contrast their form to the VOMPTI form.

What did they leave out that we leave in?

What do they consider that isn’t on our form?

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[August Winter]

Scott, thanks for posting. I liked this article because it highlights the variations in the practice of clinical reasoning and mentorship. Overall our CRF and the one posted here are fairly different as far as length, organization, and content area, all due to the fact that their form is completed within a 90 minute evaluation session. I would be curious what people thought of their model versus what we do in our program. Benefits or drawbacks of each?

As far as items in our form not found in the Baylor form, the majority of them concern the more retrospective aspects of the clinical reasoning process. Our form has an entire section for a PICO question and what we learned from it. Our form also places a greater emphasis on pattern recognition in the middle and end. I like that with the recent additions there is a greater emphasis all of the potential psychosocial factors that may be present, not just one tiny box as in the Baylor form. I also like that we must explicitly put what we are going to reassess in the following sessions, unlike in the Baylor form where the greater emphasis appears to be placed on things that weren’t day one priorities.

As far as the Baylor form, I do like the concise breakdown of the SINSS into a table. As a student I had to talk through this process with my CI, and I found it very helpful for some evaluations. I think filling out a form makes the thought process even more explicit and less rushed. I also liked the prognosis section at the end of the form which asks about the natural course of the disease, as this highlights the importance of our education about a patient’s prognosis given X, Y, Z.

Maybe in an ideal world something like these forms are used in conjunction, both in the moment and retrospectively.

[Aaron Hartstein]

Hey Eric – I think we should contact Gail J. and see why VOMPTI was not acknowledged for the clinical reasoning form. Royalties?

[Kyle Feldman]

I talked to Sarah Baker about this form and what they do during their fellowship training. She mentioned that this form was modified over the years due to the military format of PT. They do a ton of evals and very few follow ups, so this was a way to work on reflection in the moment.

She mentioned they also do reflection after mentoring and do use the long form.

I agree with August about the idea of how SINSS and some of the key ideas in this form done over and over in the moment would be very effective for early learning.

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