What are your initial impressions of Katrina’s situation?
Describe them here.
What have you noticed about Katrina’s situation while observing her consultation with the podiatrist so far? Record your observations here.
Can you think of any assumptions that you could make here, and how they might influence your thoughts about Katrina’s situation?
Before watching the next video clip, consider what questions you as practitioner would like to ask Katrina to gain a better idea of her situation. List your questions for Katrina here.
In the next space provided, list any other information that you think you would be necessary or helpful in order to gain the best possible picture of Katrina’s situation and the best course of action to support her.
Can you think of any other relevant questions you would ask of Katrina that may help you make an appropriate diagnosis?
You can provide questions that are most relevant to your practice. You do not have to follow the podiatry line of investigation, for example, as the as the purpose of this module is to enable you to experience and respond to a scenario and apply clinical reasoning.
List your questions for Katrina here:
Can you think of any other relevant questions you would ask of Katrina that may help you make an appropriate diagnosis? List them here.
Would you seek any other information to help you make an appropriate diagnosis from:
What and why?
You now have some valuable details about Katrina’s situation. This provides important information for a podiatrist, but it is also relevant to other allied health professions.
Review the notes you have taken. Analyse them carefully.
List your responses to the following questions that you should ask yourself during the information processing stage of the clinical reasoning cycle:
What information do you think is most important for assisting Katrina here?
Are there any gaps in the information you have gathered about Katrina’s situation? If yes, identify the gaps.[you will find there may be a multitude of gaps if you come from a different allied health practice from the one you see in the video!]
Can you recognise relationships or patterns between the cues that have been gathered here so far?
What are the cues and what do you think they are telling you/revealing to you? Do they enable you to infer anything about Katrina’s situation? What can you infer?
What alternative inferences are worth considering?
Can you match Katrina’s situation to any past situations you have encountered with clients before? (Note:this is usually an expert thought process, which relies on your accumulated wealth of clinical experience.However, you may be able to relate it to situations you have already encountered – either in the university’s teaching clinic, or case studies in tutorials, for example.)
Can you predict any outcomes for Katrina? (What can Katrina expect to gain out of having this consultation?)
This is where you synthesise all the information you have gathered and processed in the exercises above in order to make a diagnosis of Katrina’s problem/s. This step enables you to identify the most significant problems or issues for the client.
It is an important step for the next stage, where you will identify the goals of care and course of action.
After identifying and prioritising any problems and issues for Katrina that may require intervention, it is time to establish the goals of care and consider how these goals can be achieved between the practitioner and client. Write your responses to the following questions:
What is the desired outcome for Katrina?
What outcome might Katrina want?
What are the goals for achieving this desired outcome for Katrina? Make sure your goals are SMART (Specific, (Measurable, (Achievable, (Realistic and (Timely)
In this stage you select the most appropriate course of action, as well as deciding who is best placed to undertake any interventions, if you feel they are necessary.
Describe what you want to happen for Katrina.
If you have recommended interventions, who should undertake these interventions?
This stage refers to your assessment of the effectiveness of the prescribed interventions and determining whether the situation has improved for the client.
However, in this situation, you are not able to evaluate specific outcomes for Katrina, as there is no follow-up in this exercise. Instead, we would like to show you the podiatrist’s diagnosis and his treatment recommendations here. Then in the next stage you will be able to review and evaluate both your own process of reasoning as well as the podiatrist’s and compare and contrast the two.
Reflection is a crucial part of clinical practice generally – as well as clinical reasoning. It is the final step of the clinical reasoning cycle and enables you to critically analyse and review your practice in order to refine, improve, or change it (Levett-Jones & Hoffman, 2013, p. 6).
Think back to your very first impressions of Katrina in Stage 1 of the clinical reasoning cycle. Look at your notes, but also try to recall whether you made any assumptions about Katrina and her situation that could have influenced your thoughts and shaped your diagnosis. If so, consider why this influenced your thinking. This can be a challenging reflective exercise – but it is integral to being a good critical thinker, and being aware of some of the biases we may carry that can lead to errors in our clinical reasoning.
What have you learnt from this process?
What you could have done differently?
Think back again to the cues that you found in the information-gathering stage. Can you think of any subtle cues that you may have missed during the consultation? What could have been the outcome of missing this/these cues?
Could any of these missed cues have resulted in an adverse event or pose health problems later on?