Clinical reasoning and hypothesis generation in expert clinical swallowing examinations.

CONCLUSIONS & IMPLICATIONS: Variability in reported dysphagia practice is likely the result of a patient-centred assessment process characterized by iterative cycles of fact-gathering in order to generate and test clinical hypotheses. This has implications for the development of novel assessment tools, as well as professional development and education of novice SLTs. What this paper adds What is already known on the subject CSE practices are reportedly variable, which has led to calls for more stringent, standardized assessment tools. Emerging evidence suggests that this variation is non-random, but may arise from clinical reasoning processes. What this paper adds to existing knowledge We directly observed expert SLTs conducting CSEs and identified patterns in practice that were consistent across all CSEs evaluated. These patterns were consistent in structure, whereas the content of the assessment items varied and was tailored to individual patient presentation. Overall, expert SLTs engaged in balanced cycles of inductive hypothesis generation and deductive hypothesis-testing, a hallmark of good clinical assessment and practice. What are the potential or actual clinical implications of this work? Ensuring quality CSE requires a more nuanced approach that considers the role of clinical reasoning in SLTs' decision-making and the potential unintended negative consequences of standardized assessment tools. PMID: 32185861 [PubMed - as supplied by publisher]
Source: International Journal of Language and Communication Disorders - Category: Speech-Language Pathology Authors: Tags: Int J Lang Commun Disord Source Type: research