Optometrists’ Clinical Reasoning Made Explicit
Bibliographic record
Abstract
PURPOSE: Because the clinical reasoning processes engaged in by practicing optometrists have not previous been investigated, until now, there has been no way of knowing whether models of clinical reasoning from other health professions can be transposed to optometry. The purpose of this study has therefore been twofold: making explicit the clinical reasoning processes of optometrists at both the "competent" and "expert" levels and comparing these processes to highlight the characteristics of clinical reasoning expertise. METHODS: Four competent-level optometrists and four expert-level optometrists participated in this qualitative study. Each optometrist performed a complete optometric examination on a preselected patient. Each of these examinations was recorded on a DVD video and followed by a feedback session, also captured on a DVD video. The feedback session was conducted using techniques inspired by a form of interview called the "explicitation interview," aiming to describe optometrists' mental actions and the time sequence of these actions throughout the examination. RESULTS: The results indicate that optometrists' clinical reasoning is patient centered and includes both analytical and nonanalytical modes of reasoning. When compared with a competent-level optometrist, an expert-level optometrist is more patient centered, formulates an earlier mental representation of the patient's clinical situation (including diagnosis formulation), plans examinations more thoroughly, is able to analyze and reflect during cognitively demanding tasks, and draws up his or her care management plan throughout the entire examination. CONCLUSIONS: The verbalization of optometrists' clinical reasoning processes represents a first step toward a better understanding of this competency. The impact of this research on optometric education is discussed. The results open doors to further research in the field, for example, toward defining the stages of clinical reasoning development among optometry students and professionals.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.014 | 0.062 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.002 | 0.005 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.001 | 0.004 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".