Journal of evaluation in clinical practice
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Review
Dual process models of clinical reasoning: The central role of knowledge in diagnostic expertise.
Research on diagnostic reasoning has been conducted for fifty years or more. There is growing consensus that there are two distinct processes involved in human diagnostic reasoning: System 1, a rapid retrieval of possible diagnostic hypotheses, largely automatic and based to a large part on experiential knowledge, and System 2, a slower, analytical, conscious application of formal knowledge to arrive at a diagnostic conclusion. However, within this broad framework, controversy and disagreement abound. In particular, many authors have suggested that the root cause of diagnostic errors is cognitive biases originating in System 1 and propose that educating learners about the types of cognitive biases and their impact on diagnosis would have a major influence on error reduction. ⋯ The two processing modes are better understood as a consequence of the nature of the knowledge retrieved, not as independent processes.
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Religious fatalism has for decades been pointed out as a barrier to cancer screening attendance and several studies suggest interventions to decrease fatalism, given its negative impact on the uptake of cancer screening. ⋯ Our main thesis is that interventions do not necessarily have to decrease religious fatalism to increase screening.
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In the context of a major health crisis, health professionals must first compare patients' recovery prospects, thus giving priority to the goal of saving the greatest number of lives. ⋯ The authors' proposed protocol has advantages over the other two protocols due to its greater practicality and capacity to account for egalitarian and consequentialist principles simultaneously. It aims at saving as many lives as possible within the constraints of fairness. Furthermore, the proposed protocol avoids discrimination against people with disabilities without, at the same time, promoting discrimination against the elderly.
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Numerous studies have demonstrated that our healthcare systems and medical education programs are fundamentally flawed. In North America and Europe, most systems were built upon values and structures that have historically benefitted middle and upper class males of European descent in the global north. As a result, there continue to be systemic biases that are pervasive throughout our healthcare systems and medical education programs. ⋯ In the months leading up to the conference, each writing team explored a specific topic related to clinical reasoning and racial equity. The papers, presented during the virtual conference are now available in this issue of the Journal for the Evaluation of Clinical Practice. In addition, 6 more publications were added to this special topic to showcase new evidence and theory that builds on the recommendations in the three core papers.
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Charters and Heitman have recently argued that epidemic status is lost once the disease becomes 'accepted into people's daily lives and routines, becoming endemic-domesticated-and accepted'. This is a normativist, subjectivist approach to epidemic classification; that is, it is both value-laden, and dependent on the attitudes of the population. In this article, we argue for an alternative approach: a value-dependent realist account of epidemic-status. ⋯ To frame the argument we draw from complexity theory, arguing that human populations can be viewed as complex systems, and epidemic-status as an emergent property of a complex system. We propose aggregating the normative standards relevant to labeling a disease as an epidemic, and use this as our indicator for both the beginning, and the end of epidemics. An epidemic ends, we argue, once the burden of disease drops below an objective but distinctly normative 'epidemic threshold'.