An Investigation into the Clinical Reasoning of Chinese Medicine
- Publication Type:
- Thesis
- Issue Date:
- 2024
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๐๐ฎ๐ฐ๐ธ๐ด๐ฟ๐ผ๐๐ป๐ฑ: This thesis examines clinical reasoning in the practice of Chinese medicine and acupuncture, a critical yet under-researched domain. Clinical reasoning is essential for translating theoretical knowledge into practical patient care.
๐๐ถ๐บ: The study's primary objective was to compare the clinical reasoning processes of both experienced and student practitioners using simulated cases of insomnia and migraine. A secondary objective was to confirm the clinical validity of the 'Model of Professional Thinking' as a basis for evaluating clinical reasoning for Chinese medicine and acupuncture.
๐ ๐ฒ๐๐ต๐ผ๐ฑ๐: Employing a mixed-methods approach, the study enrolled 39 participants, comprising experienced Chinese medicine practitioners with at least seven years of clinical practice and final-year student practitioners. Participants completed questionnaires and undertook clinical interviews for the simulated cases. This was then followed by a second interview and video recording which required the participants to recall their reasoning processes and explicate their cognitive reasoning.
๐ฅ๐ฒ๐๐๐น๐๐: Twenty-six participants completed both interviews (experienced Chinese medicine practitioners n=14; final-year student practitioners n=12). Analysis of the who completed both interviews revealed distinct clinical reasoning processes in consultation, diagnosis, and treatment planning. According to the โtraditional 10 questionsโ which are used to collect patient data, there were significantly more questions asked by the experienced practitioners (p<0.05) in the areas of the chief complaint, personal history, pain location and causes of insomnia, stool, body pain areas and diet in insomnia case; and pain, location of the pain and individual history in migraine case compared to the final-year student practitioners.
Experienced practitioners demonstrated superior skills in information collection, problem identification, action taking, and outcome evaluation. However, both groups lacked in creative thinking and new learning. The study identified common steps in clinical reasoning, indicating some aspects are coachable, while others may be intrinsic or university-acquired knowledge and skills.
The 'Model of Professional Thinking' was utilized to analyse the reasoning process, revealing that experienced practitioners showed greater creative analysis skills and confidence. They were more assured in their diagnostic conclusions, asked focused questions, and were willing to change their opinions based on new information.
๐๐ผ๐ป๐ฐ๐น๐๐๐ถ๐ผ๐ป: This study provides a foundational understanding of clinical reasoning in Chinese medicine and acupuncture, identifying an eight-step process that requires further exploration, particularly in creative thinking and new learning. The findings offer valuable insights for the development of AI diagnostic systems and future educational strategies in clinical reasoning for Chinese medicine and acupuncture practitioners.
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