Table 1 Informational concepts identified in the referral phrase analysis
From: Clinical decision-making and adaptive expertise in residency: a think-aloud study
Concept | Definition | Verbal data |
|---|---|---|
Actions | Statements related to their behaviour | The nurse has just finished her handover of the patient to Daniel: “Yes, but let’s go in right away.” |
Patient characteristics | Patient characteristics with a consequence for the diagnostic process (e.g., gender or known pathology) | Casper is treating a fallen patient who reportedly suffers from dementia. During his preparation, Casper explains: “Often, we are more generous with x-rays when they [patients] have dementia because the physical examination can be difficult.” |
Anamnesis | Patient history and description of events leading up to admission | Ellen is gaining an overview of the patient and explains while reading the electronic patient journal that the patient “…has been here for outpatient control, where she was [treated] for a distal radius fracture.” |
Peer opinion | Opinions from other physicians, both residents and experienced | Julie has taken over a complex patient from another resident. She has conferred the patient with the available supervising physician who is an orthopaedic surgeon. But she is still unsure of the medical side of the problem. She remarks, “… it’s good to talk to the tending emergency physician, as they are more attuned to the medical challenges…” |
Plan | Recounting the plan for receiving and treating the patient | Mark is treating a patient who has fallen and is in severe pain. He stops the physical examination and explains to the patient that as she is in so much pain, “…we will do an x-ray first, and then I can examine you further if there’s no visible fracture.” |
Sign | Visible symptoms or test results related to the present diagnosis or patient state | Christina is examining a patient with suspected fracture on the ankle. She compares the sizes of the patients’ ankles and notes, “There’s a visible swelling here.” |
Value | The meaning of symptoms to the diagnosis | During the handover from the EMTs, Mark retrospectively explains that some of the reported values puzzle him. He reflects that this affects his decision-making: “I start to consider… because you shouldn’t receive a random patient with a heart rate of 35.” |
Referral | The referral notes are written by the referring physician before admission | Anne has been notified that there is a patient incoming, and remarks that “…I will look him up… [And] see if there’s a referral note…” |