Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Apr;8(2):61-71.
doi: 10.30476/jamp.2020.82230.1050.

A novel model of clinical reasoning: cognitive zipper model

Shahram Yazdani  1 , Maryam Hoseini Abardeh  1
Affiliations

A novel model of clinical reasoning: cognitive zipper model

Shahram Yazdani et al. J Adv Med Educ Prof. 2020 Apr.

Abstract

Introduction: Clinical reasoning is a vital aspect of physician competence. It has been the subject of academic research for decades, and various models of clinical reasoning have been proposed. The aim of the present study was to develop a theoretical model of clinical reasoning.

Methods: To conduct our study, we applied the process of theory synthesis in accordance with the Walker and Avant's approach. First, we considered clinical reasoning as a focal concept of our study. Second, a search was carried out for the period 1984-2018, using the PubMed, Google Scholar, PsycINFO, ERIC, ScienceDirect and Web of Science databases to review the literature to identify factors related to the clinical reasoning and the nature of their relationships. Third, we organized clinical reasoning into an integrated and efficient representation of the clinical reasoning.

Results: According to this study clinical reasoning is the iterative process of intermediation between the recalled clinical knowledge and the patient's represented problem in the clinicians' active memory. We analogize the process of clinical reasoning to the process of closure of a cognitive zipper. The recalled knowledge in clinician's memory resembles to one side of zippers teeth and the evolving representation of the patient's problem resembles the other side of zippers teeth. So, the results of this study are presented in three models: [1] multi-layer knowledge structure model, [2] problem representation model and [3] cognitive zipper model of diagnostic reasoning.

Conclusion: We propose a developmental model of clinical reasoning. Several studies have tried to present models and theories to clarify clinical reasoning, but it seems that these theories and models could only explain part of this complex process and not the whole process. Cognitive zipper model, due to its developmental structure, can illustrate the clinical reasoning process in more details than other models do.

Keywords: Clinical decision making; Judgment; Problem solving.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Cognitive zipper model
Figure 2
Figure 2
Modes of inquiry
See this image and copyright information in PMC

References

    1. Norman G. Research in clinical reasoning: past history and current trends. Med Educ. 2005;39(4):418–27. - PubMed
    1. Park WB, Kang SH, Myung SJ, Lee YS. Does objective structured clinical examinations score reflect the clinical reasoning ability of medical students? The American journal of the medical sciences. 2015;350(1):64–7. - PMC - PubMed
    1. Pelaccia T, Tardif J, Triby E, Charlin B. An analysis of clinical reasoning through a recent and comprehensive approach: the dual-process theory. Medical education online. 2011;16(1):5890. - PMC - PubMed
    1. Zamani S, Amini M, Masoumi SZ, Delavari S, Namaki MJ, Kojuri J. The comparison of the key feature of clinical reasoning and multiple choice examinations in clinical decision makings ability. Biomedical Research. 2017;28(3):1115–9.
    1. Higgs J, Jones MA, Loftus S, Christensen N, editors. Clinical Reasoning in the Health Professions E-Book. US: Elsevier Health Sciences; 2008.