Assisting the Learning of Clinical Reasoning by Veterinary Medical Learners with a Case Example

Abstract

Effective clinical reasoning is essential for veterinary medical education, particularly in managing complex cases. This review explores strategies for learning clinical reasoning by veterinary medical learners, using a case example of mastitis to illustrate key concepts. Clinical reasoning encompasses cognitive, metacognitive, social, and situational activities, yet the literature on practical applications in veterinary education remains limited. The review discusses various stages of clinical reasoning, including data collection, problem representation, differential diagnosis, and management planning. It emphasizes the importance of integrating client-centered care and iterative evaluation into the clinical decision-making process. Key learning strategies include facilitation in using the domains of clinical reasoning-concepts, data collection, and analysis, taking action, and reflection on encounters. This review highlights best practices such as forward and backward reasoning, reflective practice, and the use of practical examples to enhance learners' diagnostic accuracy and patient outcomes. The insights provided aim to enhance the training of veterinary learners, ensuring they can navigate day 1 as well as complex cases with improved diagnostic accuracy and patient outcomes.

Keywords: analysis of data; clustering of data; data collection; health interview; problem representation; reflection; veterinary clinical encounter.

Figure 1

A diagram presenting alterations in the mammary secretion, udder, or cow commonly used as signs indicative of bovine mastitis. Mild form—changes only in the mammary secretion (alterations in color, consistency, smell, and the presence of admixtures) being the result of inflammation of the ducts and/or alveoli within the gland. Moderate form—changes in the secretion and the udder (alterations in the color, consistency and temperature of the udder, and the presence of tenderness) resulting from the spread of inflammation to deeper structures of the mammary gland. Severe form—changes in the secretion, udder, and cow (presence of signs of generalized illness) resulting from the spread of infection and absorption of inflammatory products into the general circulation.

Figure 2

Practical use of types of clinical reasoning in the management of clinical encounters using the analytical model of clinical reasoning applicable to veterinary clinical encounters. After each step in the clinical reasoning (shown by the lighter rectangles), the learner should seek the appropriate mental representation (e.g., illness scripts) to match with the presented problem/syndrome (seeking a diagnosis or an appropriate management strategy). If the diagnosis is reached, the next stage of the clinical reasoning should be management, as mutually agreed with the client. Reflection and self-monitoring should be used after each decision-making step that may result in a change to the accepted decision (self-monitoring).

Figure 3

Veterinary medical case management domains and their components that may be used in any order, subsequently or concurrently.

Figure 4

Health interview in veterinary encounters should be hypothesis-driven. Similar principles apply to an encounter involving a single patient or a population.

Figure 5

Examination of the environment should be hypothesis-driven. As the environment may change, temporal recording is recommended.

Figure 6

A brief but complete clinical examination in every veterinary medical encounter is recommended. Adjustments to the routine should be made based on patient signalment, presenting complaint, hypothesis driving the data collection, and contextual circumstances (e.g., available time, encounter complexity, and urgency).

Figure 7

Post-mortem examination should be hypothesis-driven and complete whenever possible. As clinical and etiologic situations may change over time, permanent recording is recommended.

Figure 8

Considerations in the selection of samples and ancillary techniques/tests, applicable to veterinary medical encounters, useful in the collection of data step in the clinical reasoning process.

Figure 9

Pattern-recognition intuitive-type clinical reasoning.