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Sílvia Mamede Senior researcher

s.mamede@erasmusmc.nl

Clinical reasoning

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Research

My research programme has three main themes: (1) clinical reasoning and diagnostic error, studying the mental processes through which physicians make diagnoses, the sources of diagnostic errors, and how they can be minimised; (2) instructional approaches to develop medical students’ clinical reasoning, focusing on the design and test of approaches to optimise learning from practice with clinical problems; (3) reflection and reflective practice in medicine, investigating the nature of reflective practice, the characteristics of reflective physicians, how reflection can be fostered and the influence of reflection on learning and performance.

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.

I have some experience with research on reasoning as applied to medical diagnosis, especially experimental studies aimed at understanding the nature of physicians’ reasoning, factors that influence reasoning, sources of mistakes, and how they can be counteracted. My work has also made me familiar with research design and tools to investigate learning, in particular the effect of different educational interventions on learning processes and learning outcomes in undergraduate and postgraduate education as well as among practicing physicians.