Get to know Sílvia
How do physicians reason to diagnose and manage patients’ problems? What can go wrong in clinical reasoning and how mistakes can be minimized? How do medical students become able to reason clinically and what can be done to foster learning? These questions, intriguing and highly consequential to patients and physicians alike, have long fascinated me. My research team has studied them through both fundamental and applied research using observational and particularly experimental methods. We aim to build upon knowledge and tools from cognitive and educational psychology to conduct research that impacts medical education and health care.
My research programme has brought three major novel contributions to our domain:
- We have developed and tested an approach for deliberate reflection in medical diagnosis which recent systematic reviews have shown to be the most consistently effective strategy to improve diagnostic performance.
- Our experiments have demonstrated that physicians’ diagnostic reasoning can be adversely influenced by irrelevant factors, such as salient distracting features and difficult patients’ behaviours, and provided the first experimental evidence that bias in reasoning can cause diagnostic errors and can be counteracted by reflection.
- We developed an instructional approach for practice with clinical cases that proved effective to increase medical students’ diagnostic competence and has been employed for the teaching of clinical reasoning.
I did not think of becoming a researcher until I started working in postgraduate education programmes for young physicians. Then, the question of how we could help them become good clinicians brought me closer to research. And clinical reasoning, in particular, attracted my attention not only because it critically determines physicians’ performance, but also because it is possibly an unbeatable example of the extraordinary power of our brain. Physicians have to navigate through an extremely broad and complex knowledge basis to understand and solve patients’ problems. The quest to understand how they do that, how in the course of their training they become able to do that, is fascinating. Indeed, the challenge of discovering more about how people learn and how learning can be fostered is so interesting that it might keep me motivated to do the work I do. But also helpful is the hope that our discoveries can contribute a bit, even if only a bit, to make education better.
My research activities can be grouped into three main areas:
- Clinical reasoning and diagnostic error
Research on the nature of diagnostic reasoning, the sources of cognitive diagnostic errors, and how they can be minimised. Examples are studies on the effect of different reasoning modes on diagnostic accuracy, factors that influence physicians’ diagnostic reasoning and cognitive biases in diagnostic reasoning. Deliberate reflection, an intervention developed by my research team, has been appointed as the most consistently successful cognitive intervention to reduce diagnostic reasoning errors.
- The teaching of clinical reasoning
Research on educational strategies to develop medical students’ clinical reasoning, focusing on the design and test of instructional approaches to optimise learning from practice with clinical problems. These studies have shown the effectiveness of strategies such as deliberate reflection and self-explanation, which have been incorporated in the teaching of clinical reasoning in undergraduate medical curricula in schools for example in Canada and Brazil.
- Reflection and reflective practice in medicine
Research on the nature of reflective practice in medicine, how reflection can be fostered and the influence of reflection on learning and performance. Starting with studies of what characterizes reflective practice in medicine, this research is presently focused on approaches to develop reflective reasoning and on the use of reflection upon clinical problems as a tool to foster learning of relevant scientific knowledge.
Projects within these three main areas have been carried out in collaboration with colleagues from the ErasmusMC and the Erasmus School of Social and Behavioural Sciences, and researchers from several universities in different countries such as Switzerland, Canada, Singapore and Brazil.
- Guest lectures in different national (e.g. University Medical Centre Groningen; Utrecht University College Roosevelt) and international (e.g. University of Bern; COSIMA, LMU Munich) academic centres and educational programmes.
- Supervision of bachelor, master and PhD students.
- Editorial board member for Health Professions Education and BMC Medical Education
- Mentor in the Society for Improvement of Diagnosis in Medicine Fellowship in Diagnostic Excellence.