Cognitive expertise, emotional development, and reflective capacity: clinical skills for improved pain care

Abstract

The overarching goal of medical training is to nurture the growth of knowledgeable, caring, and insightful clinicians guided by the ideals of medical professionalism. Recent definitions of professional competence identify essential clinical skills, including cognitive expertise, emotional competence, and reflective capacity. This modern framework reflects the increasingly complex nature of the patient-clinician interaction, in which the clinician must exchange diagnostic information while supportively engaging the patient on a deeper, affective level. The affective dimension can be particularly potent when pain is the primary symptom, as it is for the majority of medical visits. Unfortunately, however, current models of professionalism, used as an early guide for medical trainees to develop an understanding of the clinical exchange, largely focus on interactions in the cognitive domain. To emphasize the importance of emotions in professional development, we propose the Cognitive and Emotional Preparedness Model, which describes the clinical encounter occurring on two channels, one cognitive and the other emotional, and stresses the importance of multidimensional development in preparing the clinician to (1) communicate clinical information, (2) provide emotional support, and (3) actively reflect on experiences for continued improvement. Together, acquisition of knowledge, emotional development, and reflective skill will improve the clinical interaction.

Perspective: The proficiency of medical trainees in developing clinical skills profoundly shapes patient satisfaction and treatment outcomes. This article reviews the cognitive, emotional, and reflective development of medical trainees and presents a model illustrating how clinical development impacts pain care. For improved efficacy, pain education should be calibrated to students' developmental needs.

Figure 1. Operational diagram of the model

Cognitive expertise, Emotional development and Reflective capacity all contribute to the patient-physician interaction. The strength of evidence supporting these associations is indicated by the color of the symbols. Cognitive expertise has a clear impact on patient-physician interactions, there is good evidence to support a role for emotional skills as well. More research is needed to assess the impact of reflective capacity.

Figure 2. The Cognitive and Emotional Preparedness Model

A) Clinician with no preparation. Communication is unidirectional. Clinician’s cognitive domain is underdeveloped as shown by small blue rectangle and the clinician’s emotional experience is reactive, large yellow burst-shape. Details in text. B) Clinician with Cognitive Preparation. Information exchange is bi-directional and productive but affective support for the patient is not provided. C) Clinician with Cognitive and Emotional Preparation. Information exchange is bi-directional and patient experiences emotional support regarding their medical condition. D) Clinician with Cognitive, Emotional and Reflective Preparation. Communication is highly effective in terms of information exchange and emotional support, the reflective clinician is able to continue personal growth and professional development. Note: Because the model represents features of developing clinical expertise not necessarily limited to physicians, the term ‘clinician’ is used in the figure and throughout the text description of the model.