To the Editor,
We appreciate Dr. McQuade and Dr. Bonifacino’s thoughtful comments on the distinctions between problem representations (e.g., a clinician’s evolving internal distillation of a patient’s salient clinical issue(s)) and summary statements (e.g., the external expression – spoken or written – of the summative problem representation).
Our suggestions for how resident clinical teachers can use problem representations to promote diagnostic reasoning on rounds align with their assertions, including the importance of using semantic qualifiers and updating problem representations as cases evolve. However, we did not conceptualize problem representation as a strictly internal cognitive process.
Their distinction mirrors recent work by Dreicer and colleagues that differentiates between schemas (i.e., nuanced and partially subconscious knowledge structures driving the approach to clinical problems) and frameworks (i.e., simplified external representations of that knowledge). 1 This conceptual distinction between internal cognition and external communication of that cognition can be useful in some discourses given the challenges scholars have faced in defining clinical reasoning and its related constructs. 2
We agree that without a consistent commitment to promoting precise communication, our efforts to advance clinical reasoning education will likely miss the mark, no matter what terms we use.
Sincerely,
John C. Penner, MD.
Lindsey C. Shipley, MD.
Daniel J. Minter, MD.
Footnotes
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References
- 1.Dreicer JJ, Parsons AS, Joudi T, Stern S, Olson APJ, Rencic JJ. Framework and Schema are False Synonyms: Defining Terms to Improve Learning. Perspect Med Educ. 2023;12(1). 10.5334/pme.947 [DOI] [PMC free article] [PubMed]
- 2.Young M, Thomas A, Lubarsky S, et al. Drawing Boundaries: The Difficulty in Defining Clinical Reasoning. Acad Med. 2018;93(7):990–995. doi: 10.1097/ACM.0000000000002142. [DOI] [PubMed] [Google Scholar]