A novel model of clinical reasoning: Cognitive zipper model

Abstract

Introduction: Clinical reasoning is a vital aspect of physiciancompetence. It has been the subject of academic research fordecades, and various models of clinical reasoning have beenproposed. The aim of the present study was to develop a theoreticalmodel of clinical reasoning.Methods: To conduct our study, we applied the process of theorysynthesis in accordance with the Walker and Avant’s approach.First, we considered clinical reasoning as a focal concept of ourstudy. Second, a search was carried out for the period 1984–2018, using the PubMed, Google Scholar, PsycINFO, ERIC,ScienceDirect and Web of Science databases to review theliterature to identify factors related to the clinical reasoning andthe nature of their relationships. Third, we organized clinicalreasoning into an integrated and efficient representation of theclinical reasoning.Results: According to this study clinical reasoning is the iterativeprocess of intermediation between the recalled clinical knowledgeand the patient’s represented problem in the clinicians’ activememory. We analogize the process of clinical reasoning to theprocess of closure of a cognitive zipper. The recalled knowledgein clinician’s memory resembles to one side of zippers teeth andthe evolving representation of the patient’s problem resemblesthe other side of zippers teeth. So, the results of this study arepresented in three models: [1] multi-layer knowledge structuremodel, [2] problem representation model and [3] cognitive zippermodel of diagnostic reasoning. Conclusion: We propose a developmental model of clinicalreasoning. Several studies have tried to present models andtheories to clarify clinical reasoning, but it seems that thesetheories and models could only explain part of this complexprocess and not the whole process. Cognitive zipper model, dueto its developmental structure, can illustrate the clinical reasoningprocess in more details than other models do.

Keywords

• clinical decision making
• problem solving
• judgment