Revealing the clinical reasoning processes of infectious diseases assistants

Aim: Infectious diseases are life-threatening diseases that can be extremely complex to diagnose and treat. Physicians managing these diseases use clinical reasoning (CR) skills to make accurate and rapid decisions. CR refers to the complex thinking and decision-making processes used in clinical practice. The challenging and complex nature of infectious diseases further increases the importance of CR skills. In these diseases, symptoms and signs are often vague, diagnosis can be difficult, and more than one treatment option may be available. Additionally, the patient's condition may change rapidly and require urgent intervention. The aim of this study is to understand the CR processes of infectious diseases residents and to provide recommendations for training programs and clinical guidelines to improve these skills. Materials and method: In this study, the clinical reasoning skills of infectious diseases residents were examined. The research was conducted with a qualitative method through face-to-face and in-depth interviews with 12 infection assistants from two different institutions who completed at least 2 years as an infection department assistant. Data were collected using a pool of 5 case scenarios and a semi-structured interview guide. The scenarios were analyzed by evaluating the assistants' answers and analysis flows at each step. Interview texts were analyzed with thematic qualitative analysis. Results: A total of 12 assistant physicians from 2 different institutions were included in the study. According to research findings, assistant physicians generally adopt a systematic approach in clinical decision-making. This approach includes the steps of taking anamnesis, performing a physical examination, evaluating the examination results and reaching a diagnosis. It is seen that the clinical decision-making skills of assistant physicians develop through the practices of their instructors and senior assistants, the experiences they gain over time, and their individual efforts. It has been observed that the diagnoses made by assistant physicians and the treatments they recommend are generally correct. However, it has also been observed that assistant physicians have problems in taking history, physical examination and justifying tests in the process of reaching a diagnosis. Important factors affecting clinical decision-making included the large number of patients, short examination times, time constraints imposed by the healthcare system, differences in infrastructure between institutions, and limitations in the consultation process. It was observed that assistant physicians requested examinations in large numbers and had difficulty justifying them. It has been revealed that assistant physicians are weak in their comments and justifications regarding the follow-up process of patients, as well as in process management in complex/critical situations, rare cases or unforeseen situations. Another important data was that methods or time frames were not designed to allow assistant physicians to reflect on their experiences in the clinic. Conclusion: This study provides important information about the clinical reasoning and decision-making processes of infectious diseases residents and the factors affecting these processes. It is thought that it will constitute an important resource for improvements in medical education and clinical practices. Structured training programs and development of role model practices to improve clinical reasoning skills can make a significant contribution to improving clinical decision-making processes. In addition, contextual factors have been shown to significantly affect decision-making processes, and medical education and clinical practices need to be made sensitive to these dynamics. In this way, more accurate and effective approaches to the diagnosis and treatment of infectious diseases can be developed, and patient safety and treatment success can be increased. Key words: Clinical reasoning, clinical decision making, assistant physician, infectious diseases, medical education, clinical environment, post-graduate education, clinical contex