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Enhancing therapeutic reasoning: key insights and recommendations for education in prescribing
MG. Hartjes, MC. Richir, Y. Cazaubon, EM. Donker, E. van Leeuwen, R. Likic, YM. Pers, JD. Piët, F. De Ponti, W. Raasch, F. van Rosse, J. Rychlícková, EJ. Sanz, M. Schwaninger, SM. Wallerstedt, TPGM. de Vries, MA. van Agtmael, J. Tichelaar, EACPT...
Language English Country England, Great Britain
Document type Journal Article, Review
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BioMedCentral
from 2001-12-01
BioMedCentral Open Access
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Directory of Open Access Journals
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Free Medical Journals
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PubMed Central
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ProQuest Central
from 2009-01-01
Open Access Digital Library
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Open Access Digital Library
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Open Access Digital Library
from 2001-03-01
Medline Complete (EBSCOhost)
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- MeSH
- Pharmacology, Clinical education MeSH
- Clinical Reasoning * MeSH
- Clinical Competence MeSH
- Drug Prescriptions standards MeSH
- Humans MeSH
- Medication Errors prevention & control MeSH
- Metacognition MeSH
- Education, Medical, Undergraduate MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Review MeSH
BACKGROUND: Despite efforts to improve undergraduate clinical pharmacology & therapeutics (CPT) education, prescribing errors are still made regularly. To improve CPT education and daily prescribing, it is crucial to understand how therapeutic reasoning works. Therefore, the aim of this study was to gain insight into the therapeutic reasoning process. METHODS: A narrative literature review has been performed for literature on cognitive psychology and diagnostic and therapeutic reasoning. RESULTS: Based on these insights, The European Model of Therapeutic Reasoning has been developed, building upon earlier models and insights from cognitive psychology. In this model, it can be assumed that when a diagnosis is made, a primary, automatic response as to what to prescribe arises based on pattern recognition via therapy scripts (type 1 thinking). At some point, this response may be evaluated by the reflective mind (using metacognition). If it is found to be incorrect or incomplete, an alternative response must be formulated through a slower, more analytical and deliberative process, known as type 2 thinking. Metacognition monitors the reasoning process and helps a person to form new therapy scripts after they have chosen an effective therapy. Experienced physicians have more and richer therapy scripts, mostly based on experience and enabling conditions, instead of textbook knowledge, and therefore their type 1 response is more often correct. CONCLUSION: Because of the important role of metacognition in therapeutic reasoning, more attention should be paid to metacognition in CPT education. Both trainees and teachers should be aware of the possibility to monitor and influence these cognitive processes. Further research is required to investigate the applicability of these insights and the adaptability of educational approaches to therapeutic reasoning.
Department of Hospital Pharmacy University Medical Center Rotterdam MC Rotterdam The Netherlands
Department of Pharmacology Faculty of Medicine Masaryk University Brno Czech Republic
Department of Pharmacology Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
IRMB University Montpellier INSERM CHU Montpellier Montpellier France
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