CR & DM in PT_English
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This document discusses clinical reasoning in physical therapy. It defines clinical reasoning as the thinking that underpins clinical practice, involving cognitive, intuitive, and mental operations that lead to decision making. It discusses different types of clinical reasoning such as intuitive, reflective, inductive, deductive, and Bayesian reasoning. It also discusses the dual process theory of reasoning and the continuum between intuitive and reflective reasoning. The document explores how clinical reasoning is developed through experience, education, and different learning activities. It emphasizes that clinical reasoning involves associating related data from different categories to build clinical patterns.
CR & DM in PT_English
- 2. A pencil and a piece of paper cost an euro and ten cents. The pencil costs one euro more than the paper. How much does the pencil cost?
- 3. Sure? I´m so sorry buddies: Pencil= 1,05 Paper= 0,05 Total= 1,10 euros
- 4. intro CLINICAL REASONING in PHYSICAL THERAPY Pablo C. García Sánchez OMT1
- 5. clinical reasoning The thinking underpinning the clinical practice Cognitive, intuitive and mental operations, which lead to decision making processes at clinical health field What is for you?
- 6. Everybody confront clinical problems in a similar way, but with different approach and usually different results
- 7. INTUITION (fordward) REFLEXION (backward) INDUCTION PROSPECTIVE Experts in front of well-known problems FORWARD DEDUCTIVE BAYESIAN ANALITIC Novels & Experts in front of new problems BACKWARD
- 9. 2 systems Do they interact?
- 15. How reliable is it?
- 16. How many animals traveled with Moises in the arch?
- 17. How many animals traveled with Moises in the arch? A. Less than 1000 B. Between 1000-5000 C. Between 5000-10000 Noah did…
- 18. How reliable is it?
- 20. attention decision mixdetection & memory Who is the boss? problem solution
- 21. It is LESS important how much knowledge do U have inside… ...is MORE important how it is built and connected
- 22. Knowledge Propositional knowledge “knowing that” Research Evidence Non- propositional knowledge Craft knowledge Personal knowledge Three Forms of Knowledge Essential, Higgs and Titchen, 1995
- 27. Knowledge is stored in the brain in chunks or data-boxes This store way facilitate thinking and improve communication Signs Symptoms Personal remembering Images This is what are we going to call “categories”
- 28. Pathobiological mechanisms Physical impairments and associated structure/tissue sources TISSUE STRUCTURE HEALING phase Contributing factors YELLOW flags Precautions & contraindication P/E & Rx Activity and Participation capability/restri ction Management, treatment & prognosis Patient’s perspectives on their experience Jones, M. and D. A. Rivett (2004). "Introduction to clinical reasoning." Clinical reasoning for manual therapists: 3-24. CATEGORIES
- 29. Pathobiolog ical mechanism s Physical impairment s and associated structure/tis sue sources TISSUE STRUCTU RE HEALING phase Contributin g factors YELLOW flags Precaution s & contraindic ation P/E & Rx Activity and Participati on capability/r estriction Managem ent, treatment & prognosis Patient’s perspectiv es on their experience Data acquisition
- 30. Association of RELATED data of DIFFERENT categories build CLINICAL PATTERNS white
- 31. • Parallel nerve trunks • Weakness • Pins & Needles • “Ants running” • Worst at night Association of RELATED data of DIFFERENT categories build CLINICAL PATTERNS • Pain • Heat • Redness • Tumor • Functional deficit • Improve with cold and NSAID • Worst with movement inflammation neurogenic pain
- 32. What are we going to do with this knowledge? intuition cognition We´ll do it nonconciously… Which ones? Discuss it 3´with your partner
- 33. What are we going to do with this knowledge? cognition Mental processes list: 1 2 3 4 5 6 7 8
- 34. Anything else? metacognition “Awareness and ability to think about your thinking” Wanna share any examples with the class?
- 35. Inductive reasoning Reflective BEFORE action Reflective IN action Reflective AFTER action Deductive reasoning Schon, D. A. (1983). La formación de profesionales reflexivos. Ryan, S. and Higgs J (2008). ”Teaching and learning clinical reasoning." Clinical reasoning in the health professions: 379-387.
- 36. CR & DM Errors Source of knowledge Low evidence Poor research Physiotherapist Intuition Cognitive Cognition Metacognition Assessment Examination Tools Interpretation Treatment Techniques Health system
- 39. Discrete Well defined Amenable to technical solutions Complex Multifactorial Changing Poor defined
- 42. 0 10 20 30 40 50 60 70 80 EBP Intuition Expertise & CR Pat opinions Which are the basis of PT decisions?
- 43. 5% only take in account patient beliefs in their decisions
- 44. 0 10 20 30 40 50 60 70 80 EBP Intuition Expertise & CR Pat opinions Which are the basis of PT decisions?
- 45. 15% only take in account EBP in their decisions
- 46. INTUITI ON (fordwar d) REFLEXION (backward) HYPOTHETIC DEDUCTIVE Novels & Experts in front of new problems BACKWARD
- 48. INTUITION (fordward) INDUCTION PROSPECTIVE Experts in front of well-known problems FORWARD
- 49. experience intuition cognition reflective Educating intuition, Hogarth, 2001 (adapted)
- 52. Case studies
- 54. “Overflow/Sublimation of evidence” How to start to make decisions in each area/cathegory?
- 55. Mechanic Ischemic On an spot, well localized area Improve with heat
- 60. Pablo César García Sánchez https://slowpt.com/ @pcgarcias pcgarciasanchez@Gmail.com
Editor's Notes
- #5: Qué espero de la charla: Que através de mostrarles la experiencia del trabajo con el RZ C en la UEM, que al menos cada uno de esos perfiles os llevéis algo para casa
- #6: Digo lo de memoria de trabajo? Y ya que para muchos de uds este es un tema novedoso quiero que retengan en su memoria de trabajo durante la ponencia esta definición de RzC. Es una definición muy simple, incompleta pero a la que podrán volver siempre que pierdan de vista el concepto de RzC
- #8: Which is better?
- #10: ESTO TIENE MUCHO TEXTO…
- #11: ESTO TIENE MUCHO TEXTO…
- #12: ESTO TIENE MUCHO TEXTO…
- #15: ESTO TIENE MUCHO TEXTO…
- #21: ESTO TIENE MUCHO TEXTO…
- #22: ESTO TIENE MUCHO TEXTO…
- #23: ESTO TIENE MUCHO TEXTO…
- #25: Knowledge: Clasificación y fuentes Three Forms of Knowledge Essential (Higgs & Titchen, 1995): Propositional knowledge “knowing that”: adquired Non-Propositional knowledge Professional craft knowledge “knowing how” allows us to use propositional knowledge in practice Personal knowledge: knowledge acquired through life that shapes personal perspectives, beliefs and attitudes Knowledge linked to practical use (professional/clinical) is more accessible. Knowledge is constantly changing . Sources of knowledge: Research based knowledge Experience based knowledge - critical reflection of your own Knowledge, its basis, the assumptions that underpin your beliefs Requires critical appraisal (research & personal knowledge /reasoning)
- #26: Niveles
- #27: Niveles
- #28: Niveles
- #30: Patrones clínicos
- #31: Hypothesis Categories Pathobiological mechanisms Physical impairments and associated structure/tissue sources Activity and Participation capability/restriction Patient’s perspectives on their experience Contributing factors Precautions & contraindications P/E & Rx Management & treatment Prognosis Jones, M. and D. A. Rivett (2004). "Introduction to clinical reasoning." Clinical reasoning for manual therapists: 3-24.
- #32: Hypothesis Categories Pathobiological mechanisms Physical impairments and associated structure/tissue sources Activity and Participation capability/restriction Patient’s perspectives on their experience Contributing factors Precautions & contraindications P/E & Rx Management & treatment Prognosis Jones, M. and D. A. Rivett (2004). "Introduction to clinical reasoning." Clinical reasoning for manual therapists: 3-24.
- #33: Estos patrones clínicos forman información prototípica relevante. Y no solo son diagnósticos
- #34: Estos patrones clínicos forman información prototípica relevante. Y no solo son diagnósticos
- #35: Estos patrones clínicos forman información prototípica relevante. Y no solo son diagnósticos
- #37: Estos patrones clínicos forman información prototípica relevante. Y no solo son diagnósticos
- #38: Aprovechar para introducir a SchonError habitual es confundir la prueba práctica con un examen oral
- #39: Niveles
- #41: Estos son los perfiles… Relevancia de la charla
- #42: Cómo son los problemas a los que nos enfrentamos los PT What do you think about time?
- #43: Y es que luego además los PT nos empeñamos en trabajar con un enfoque b-p-s… Intentamos tener impacto no solo sobre la disfunción, si no también sobre la def y disc… Y además no solo nos centramos en el dx de fisioterapia como bien ha dicho la profesora… si no que enfocamos el tratamiento desde otros puntos de vista
- #44: Seguro que nos hablan luego…
- #45: 27 pacientes 26-40 Público y privado
- #46: Al menos el 5%...
- #47: 27 pacientes 26-40 Público y privado
- #48: Al menos el 15%...
- #49: Which is better?
- #52: Which is better?
- #53: Cómo son los problemas a los que nos enfrentamos los PT
- #54: Aprovechar para introducir a SchonError habitual es confundir la prueba práctica con un examen oral
- #55: Aprovechar para introducir a SchonError habitual es confundir la prueba práctica con un examen oral
- #56: Aprovechar para introducir a SchonError habitual es confundir la prueba práctica con un examen oral
- #57: Aprovechar para introducir a SchonError habitual es confundir la prueba práctica con un examen oral
- #58: Aprovechar para introducir a SchonError habitual es confundir la prueba práctica con un examen oral
- #59: Toma de decisiones por sumación o DESBORDE o SUBLIMACIÓN de evidencia
- #60: Aprovechar para introducir a SchonError habitual es confundir la prueba práctica con un examen oral
- #61: Toma de decisiones por sumación o DESBORDE o SUBLIMACIÓN de evidencia
- #62: Toma de decisiones por sumación o DESBORDE o SUBLIMACIÓN de evidencia
- #63: Toma de decisiones por sumación o DESBORDE o SUBLIMACIÓN de evidencia
- #65: Vamos a hablar en esta charla de los 3 primeros