Abstract
Proficient clinical reasoning is a critical skill in high-quality, evidence-based
management of swallowing impairment (dysphagia). Clinical reasoning in this area of
practice is a cognitively complex process, as it requires synthesis of multiple sources
of information that are generated during a thorough, evidence-based assessment process
and which are moderated by the patient's individual situations, including their social
and demographic circumstances, comorbidities, or other health concerns. A growing
body of health and medical literature demonstrates that clinical reasoning skills
develop with increasing exposure to clinical cases and that the approaches to clinical
reasoning differ between novices and experts. It appears that it is not the amount
of knowledge held, but the way it is used, that distinguishes a novice from an experienced
clinician. In this article, we review the roles of explicit and implicit processing
as well as illness scripts in clinical decision making across the continuum of medical
expertise and discuss how they relate to the clinical management of swallowing impairment.
We also reflect on how this literature may inform educational curricula that support
SLP students in developing preclinical reasoning skills that facilitate their transition
to early clinical practice. Specifically, we discuss the role of case-based curricula
to assist students to develop a meta-cognitive awareness of the different approaches
to clinical reasoning, their own capabilities and preferences, and how and when to
apply these in dysphagia management practice.
Keywords
dysphagia - clinical reasoning - dual-cognitive processing theory - case-based curriculum
