Clinical Reasoning
Just because you think of a diagnosis first doesn’t mean you’re right!
miller’s pyramid
The figure above represents the developmental steps for all learners. The base represents learners who ‘know’ the material in question (like knowing that sodium balance is largely regulated by the kidneys). The next layer up represents when learners ‘know how’ to use the information in a systematic way (like knowing how to use the fractional excretion of sodium or FENA equation). Above that is “shows how” which represents when a learner uses information in a conscious and conspicuous manor (like using the FENA in a presentation to narrow a diagnosis to intrinsic kidney failure vs dehydration). At the top of Miller’s Pyramid says ‘does’ which represents the point at which the learner makes a habit of using the knowledge appropriately (so that the FENA is used in the discussion of every patient in whom renal function is an issue).
critical thinking
To understand critical thinking you have to understand the forces that guide our thinking. These are powerful, hard-wired pathways which have evolved over eons and have made our very existence possible.
You may recognize “Lucy” the “first human”. Imagine Lucy scrounging for roots to eat in the Serengeti. Suddenly she hears rustling in the nearby trees. She has two choices: 1) assume that the rustling is from a saber toothed tiger about to leap on her or 2) think about the various things that could cause the trees to make a rustling sound like squirrels, the wind, tigers, or other hominids. If Lucy’s first response was to reason things out I’m sure you can see that she would not survive long enough for there to be offspring who would one day turn into us. On the other hand, if she makes a snap decision with a high potential to be wrong but also a high potential for saving her life that will be the preferred system of thinking.