Clinical decision making and clinical reasoning

What is Clinical Decision Making?

On this page you will find content on:

Defining clinical decision making and how it links to clinical reasoning.
Factors influencing clinical decision-making.
How experienced health professionals can share knowledge to guide the development of clinical decision-making skills.
Strategies for supporting health professional learners or students to develop their clinical decision-making skills.
A link to access coaching questions to facilitate clinicial decision making with students.

Clinical decision-making links to clinical reasoning

Clinical decision making and clinical reasoning are terms often used interchangeably in the literature and in health care environments. While clinical reasoning refers to the overall process of thinking during clinical practice, clinical decision making emphasises the outputs or decisions from the process of thinking (Higgs & Jensen, 2019).

“Clinical decision making is both an outcome of and a component of clinical reasoning” (Smith & Higgs, 2019. p445).

In this short presentation Alis Moores, Clinical Education Leader for Program Quality within the Occupational Therapy Clinical Education Program of Queensland Health, discusses clinical decision making and describes decision-making processes typical to health professionals.

Factors influencing clinical decision-making

A range of factors influence clinical decision making in health care environments. These include:

the context of care
the client and their life experience
the knowledge or theory of the health professional, and
the health professional’s personal beliefs about their practice.

These factors are interrelated and guide clinical decision-making to varying degrees as health professionals engage with clients and their professional colleagues in the care environment.

Let's now look at each of these factors in more detail. In this next presentation Cate Fitzgerald, Statewide Program Manager for Clinical Education and Training for the Occupational Therapy Clinical Education Program of Queensland Health, discusses factors that influence and derail clinical decision making within health contexts.

Experienced health professionals sharing knowledge

Experienced health professional’s clinical decision making is characterised as being complex and non-linear. It is difficult for less experienced health professionals and students to understand advanced clinical decision making by observation alone. To share clinical decision-making, experienced health professionals need to first develop awareness of their own clinical decision-making and the knowledge which underpins it.

In this next presentation Alis Moores, Clinical Education Leader for Program Quality within the Occupational Therapy Clinical Education Program of Queensland Health, describes how health professionals can develop their awareness of their own decision making as a first step to being able to share it with others to support decision making skill development.

Strategies supporting the development of clinical decision-making skills

Health professionals often take the role of clinical educator or supervisor of students or staff who are new to a clinical area. Novice learners or students will come to a clinical environment with differing knowledge, experience, and therefore decision-making skills to those of their more expert educators or supervisors. Exploring the decision-making characteristics of both novice learners and more experienced health professionals can support how to best approach facilitating the clinical decision-making or reasoning of students.

A range of key strategies for supporting students as novice health professional learners to develop their clinical decision-making skills can be used by clinical educators or supervisors. Strategies include:

facilitating reflective practice
use of coaching questions and structured decision-making support tools
learner centred feedback and
clinical educators articulating their decision-making and clinical reasoning (Danza & Rodger, 2018; Molloy et al, 2020; Moores & Fitzgerald, 2016; Noble et al, 2020).

In this next presentation, Cate Fitzgerald, Statewide Program Manager for Clinical Education and Training for the Occupational Therapy Clinical Education Program of Queensland Health, describes the difference between novice learner and expert clinical decision making and discusses strategies for supporting the development of clinical decision making in supervision or placement education.

In this next video, Associate Professor Jodie Copley from the School of Rehabilitation and Health Sciences, University of Queensland discusses some practical strategies supervisors can adopt to demonstrate their own clinical reasoning and decision making to students, which can then assist students to develop these skills:

Other resources to support student clinical reasoning

References:

Please Note: References remain valid until superseded by later research. The resources referenced here are regularly reviewed and are considered current and relevant to the topics presented.

Dancza, K., & Rodger, S., (2018). Implementing occupation- centred practice: A practical guide for occupational therapy practice learning. Routledge.
Higgs, J., & Jensen, G. M., (2019). Clinical Reasoning: Challenges of interpretation and practice in the 21st century. In: Higgs, J., Jensen, G. M., Loftus, S., & Christensen, N., (Eds), Clinical Reasoning in the Health professions. Elsevier.
Higgs, J., & Jones, M., (2019). Multiple spaces of choice, engagement and influence in clinical decision making. In: Higgs, J., Jensen, G. M., Loftus, S., & Christensen, N., (Eds), Clinical Reasoning in the Health professions. Elsevier.
Molloy, E., Boud, D., & Henderson, M. (2020). Developing a learning-centred framework for feedback literacy, Assessment & Evaluation in Higher Education, 45:4, 527-540,
Moores, A., & Fitzgerald, C., (2016). New graduate transition to practice: how can the literature inform support strategies? Australian Health Review, 41(3), 308-312.
Noble, C., Billett, S., Armit, L. et al., (2020). “It’s yours to take”: generating learner feedback literacy in the workplace. Adv in Health Sci Educ 25, 55–74 Schon, D. A., (1983). Educating the reflective practitioner: Towards a new design for teaching and learning in professions. Jossey- Bass.