Elisabeth M Oehrlein, Silke Schoch, Kelsie Majercak, Laura Elisabeth Gressler, Ryan C Costantino, T Rosie Love, Eleanor M Perfetto
Development and Testing of a Chronic-Disease Patient Experience Mapping Toolbox
The patient
context specificity impact contextual factors complex process clinical reasoning poorly understood using situated cognition theoretical framework aim evaluate verbalized clinical reasoning processes resident physicians order describe impact presence contextual factors clinical reasoning participants viewed three video recorded clinical encounters portraying straightforward diagnoses internal medicine select patient contextual factors modified watching video recording participants completed thinkaloud protocol transcripts thinkaloud protocols analyzed using constant comparative approach iterative coding utterances analyzed emergent themes utterances grouped categories themes subthemes ten residents participated study saturation reached analysis participants universally acknowledged presence contextual factors video recordings four categories emerged consequence contextual factors 1 emotional reactions 2 behavioral inferences 3 optimizing doctor patient relationship 4 difficulty closure clinical encounter presence contextual factors may impact clinical reasoning performance resident physicians confronted presence contextual factors clinical scenario residents experienced difficulty closure encounter exhibited diagnostic uncertainty finding raises important questions relationship contextual factors clinical reasoning activities relationship might influence cost effectiveness care study also provides insight phenomena context specificity may explained using situated cognition theory