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 Sep 14;20(1):73.
doi: 10.1186/s12873-020-00367-2.

Conceptualizations of clinical decision-making: a scoping review in geriatric emergency medicine

Maria Louise Gamborg  1   2 , Mimi Mehlsen  3 , Charlotte Paltved  4 , Gitte Tramm  3 , Peter Musaeus  5
Affiliations

Conceptualizations of clinical decision-making: a scoping review in geriatric emergency medicine

Maria Louise Gamborg et al. BMC Emerg Med. .

Abstract

Background: Clinical decision-making (CDM) is an important competency for young doctors especially under complex and uncertain conditions in geriatric emergency medicine (GEM). However, research in this field is characterized by vague conceptualizations of CDM. To evolve and evaluate evidence-based knowledge of CDM, it is important to identify different definitions and their operationalizations in studies on GEM.

Objective: A scoping review of empirical articles was conducted to provide an overview of the documented evidence of findings and conceptualizations of CDM in GEM.

Methods: A detailed search for empirical studies focusing on CDM in a GEM setting was conducted in PubMed, ProQuest, Scopus, EMBASE and Web of Science. In total, 52 publications were included in the analysis, utilizing a data extraction sheet, following the PRISMA guidelines. Reported outcomes were summarized.

Results: Four themes of operationalization of CDM emerged: CDM as dispositional decisions, CDM as cognition, CDM as a model, and CDM as clinical judgement. Study results and conclusions naturally differed according to how CDM was conceptualized. Thus, frailty-heuristics lead to biases in treatment of geriatric patients and the complexity of this patient group was seen as a challenge for young physicians engaging in CDM.

Conclusions: This scoping review summarizes how different studies in GEM use the term CDM. It provides an analysis of findings in GEM and call for more stringent definitions of CDM in future research, so that it might lead to better clinical practice.

Keywords: Biases and heuristics; Clinical judgement; Cognition; Decision making; Geriatric patients; Scoping review; Young physicians.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Study selection and PRISMA flowchart
See this image and copyright information in PMC

References

    1. Braun LT, Zwaan L, Kiesewetter J, Fischer MR, Schmidmaier R. Diagnostic errors by medical students: results of a prospective qualitative study. BMC Med Educ. 2017;17(191):1–7. - PMC - PubMed
    1. Bull S, Mattick K, Postlethwaite K. ‘Junior doctor decision making: isn’t that an oxymoron?’ A qualitative analysis of junior doctors’ ward-based decision-making. J Vocational Educ Training. 2013;65(3):402–421.
    1. Chapman EN, Kaatz A, Carnes M. Physicians and implicit Bias: how doctors May unwittingly perpetuate health care disparities. J Gen Intern Med. 2013;28(11):1504–1510. - PMC - PubMed
    1. Elstein AS, Schwarz A. Clinical problem solving and diagnostic decision making: selective review of the cognitive literature. BMJ. 2002;324(23):729–732. - PMC - PubMed
    1. Croskerry P. The theory and practice of clinical decision-making. Can J Anesth. 2005;52(6):R1–R8.

Publication types