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What are the multiple foci used in
CDM?
diagnosis intervention interaction evaluation TERM 2
Dynamic contexts of CDM
DEFINITION 2 Multiple interacting, shifting, competing goals Changing stakeholder values Action-feedback loops TERM 3
Multiple variables of the CDM process
DEFINITION 3 Time pressure Personal stress High stakes outcomes Organizational norms and goals influence decisions TERM 4
What is narrative reasoning?
DEFINITION 4 Attempt to understand the patient's problem and their personal story in the context of the problem beyond the chronological sequence of events must be open to accept the patient's story must be aware of your own personal perspectives/biases PT and patient must reach consensus via collaborative reasoning TERM 5
Narrative reasoning requires what?
DEFINITION 5 organizational skills biopsychosocial knowledge communication skills
What is CDM (diagnostic reasoning)?
process of making a choice between options to decide on a course of action -- internal process biomedically driven -- cause and effect thinking/action use of procedural management to understand and manage the problem in order to effect change considered both an outcome and a component of clinical reasoning TERM 7
What is clinical reasoning?
DEFINITION 7 CDM combined with narrative reasoning understanding and interacting with the person to effect change -- collaborative biopsychosocially driven use of communicative management where you understand the problem AND the person TERM 8
As a PT, what must you be able to do
regarding patients and goals?
DEFINITION 8 Must be able to accept patients goals even if you dont agree, but also need to be reasonable and help patients understand that their goals may need to be modified or are not possible TERM 9
What should a comprehensive diagnosis
encompass?
DEFINITION 9 what is learned from the diagnostic reasoning regarding the physical problem what is learned from the narrative reasoning regarding the person TERM 10
Hypothesis Oriented Reasoning
DEFINITION 10 reflective process pattern recognition (hypothesis formation) search for supporting or negating evidence (hypothesis testing) information gathered is compared to what is already known through the research and clinical experience process continues until therapist and patient reach a consensus
How does an expert approach reflection?
reflection in action while rendering care has broad repertoire of readily recognized patterns TERM 17
How does a novice approach
reflection?
DEFINITION 17 reflection on action reflection in hindsight must use slower hypothesis testing TERM 18
What is
cognition?
DEFINITION 18 The ability to take knowledge and form in into a pattern that you recognize TERM 19
Meta cognition
DEFINITION 19 step outside yourself and look at your thought process and focus on your organization of knowledge thinking about thinking recognition of factors that limit your reasoning looks at how hypotheses and decisions were reached TERM 20
Components of cognition
DEFINITION 20 thoughtful activities knowledge recognition/ acquisition focus on info available hypotheses and decisions reached
When is knowledge organized?
During reflection TERM 22
Metacognitive Feedback
DEFINITION 22 limitation of using our own interpretive filters to become aware of our own interpretive filters Acknowledging "impostership" is critical to growth recognizing the deep feeling you don't really understand a problem or how to best manage it and the fear of being found out by patients and colleagues TERM 23
Who can help you perform metacognitive
feedback?
DEFINITION 23 peers teachers patients LOSE YOUR FEAR OF BEING WRONG TERM 24
Cognitive Decision Making Capabilities
depend on what?
DEFINITION 24 ability to ID, collect and process relevant data ability to form a relevant mental representation of decision- making situations ability to process and interpret a multitude of decision inputs to make ethical and justified decisions ability to make pragmatic (logical and reasonable) decisions in the face of uncertainty/under resourcing TERM 25
Relfexive Decision Making Capabilities
depend on what?
DEFINITION 25 awareness of the process of decision making and the influencing factors ability to monitor and evaluate decision making throughout the process ability to self-critique the experience and effectiveness of decision making ability to adapt behavior and knowledge as a result of critique
Therapist variables
breadth, depth and organization of knowledge familiarity and experience with case type reasoning proficiency communication and teaching skills TERM 32
Patient Variables
DEFINITION 32 needs, beliefs and attitudes physical and psychosocial circumstances capacity and willingness to participate in shared decision making TERM 33
Environment Variables
DEFINITION 33 Resources Time Funding Professional or regulatory requirements TERM 34
Attributes of Decision Making
DEFINITION 34 uniqueness certainty importance stability urgency familiarity congruence/conflict number of variables relevance of variables risk TERM 35
Uniqueness
DEFINITION 35 Extent to which decision are unlike other decisions
Certainty
Amount of information and clear guidelines that exist to guide interpretation of data and course of action TERM 37
Importance
DEFINITION 37 Significance of decision in relation to outcome; high potential for negative outcome TERM 38
Stability
DEFINITION 38 Extent and rate at which the environment surrounding the decision is changing or evolving TERM 39
Urgency
DEFINITION 39 Extent to which a decision must be made immediately or delayed TERM 40
Familiarity
DEFINITION 40 Extent to which the decision is similar to decisions made in the past
Relatively harder attributes that influence
decision making
unfamiliarity uncertainty multiple relevant variables changing conditions conflict high risk ethical challenges emotional challenges TERM 47
Systematic Errors in Decision Making
DEFINITION 47 misinterpreting findings as confirming a hypothesis when they indicate otherwise -- seeking to prove yourself right overemphasizing the likelihood of rare conditions -- looking for zebras making different decisions for individuals than for groups of people even though they have the same condition -- vesting in a given outcome TERM 48
Importance of Routine
DEFINITION 48
- Decision frame concept of the acts, outcomes and contingencies associated with a particular choice frame is determined by norms and habits acquired through clinical practice
- data collection, casual or formal observation, must be systematic "I don't care how you do it, as long as you do it the same way every time."
