Josephine Mertens, Leiden University Medical Centre, Leiden, The Netherlands
Ellen S. Koster, Utrecht University, Utrecht, The Netherlands
Vera H.M. Deneer, University Medical Center Utrecht, Utrecht, The Netherlands
Marcel L. Bouvy, Department of Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
Teun van Gelder, Leiden University Medical Centre, Leiden, The Netherlands
ABSTRACT
Background
Clinical reasoning is considered a core competence for pharmacists, but there is a lack of conceptual clarity that complicates teaching and assessment of clinical reasoning in pharmacy practice and education.
Objective
This scoping review was conducted to identify, map and examine the evidence on used cognitive processes and their conceptualization of clinical reasoning by pharmacists.
Methods
Seven databases were searched for relevant primary research studies in March 2021. Studies were included when cognitive processes in clinical reasoning (or surrogate terms) among pharmacists or pharmacy students addressing a clinical scenario in a pharmacy-related setting were examined. Study characteristics, conceptualizations, operationalizations and key study findings were analyzed. Results were reported using Preferred Reporting Items for Systematic reviews and Meta-Analysis extension for Scoping Reviews.
Results
Included studies examined clinical reasoning in the context of forming a diagnosis (n=8) or, therapy planning and medication review (n=5). Clinical reasoning was described as a context-dependent cognitive process whereby pharmacists apply and integrate knowledge and clinical experience to interpret available clinical data. Different terms labelled pharmacists’ reasoning that showed both analytical and intuitive approaches to clinical scenarios, separately or combined as dual process. Several diagnosis-forming studies indicated no distinct cognitive pattern as pharmacists relied on inappropriate questioning methods. Medication review studies reported an analytical preference to reasoning.
Implications
Explicate each stage of the clinical decision-making process with cognitive processes and put the clinical reasoning stage in context by using the terms “diagnostic reasoning” and “therapeutic reasoning”, respectively. Develop appropriate teaching strategies to improve pharmacists’ diagnostic reasoning.