Framework and Schema are False Synonyms: Defining Terms to Improve Learning

Clinical reasoning is an essential expertise of health care professionals that includes the complex cognitive processes that lead to diagnosis and management decisions. In order to optimally teach, learn, and assess clinical reasoning, it is imperative for teachers and learners to have a shared understanding of the language. Currently, educators use the terms schema and framework interchangeably but they are distinct concepts. In this paper, we offer definitions for schema and framework and use the high-stakes field of aviation to demonstrate the interplay of these concepts. We offer examples of framework and schema in the medical education field and discuss how a clear understanding of these concepts allows for greater intentionality when teaching and assessing clinical reasoning.

[1]  J. Cobb,et al.  Cognitive task analysis-based training in surgery: a meta-analysis , 2021, BJS open.

[2]  Amber T. Pincavage,et al.  Use of a structured approach and virtual simulation practice to improve diagnostic reasoning , 2021, Diagnosis.

[3]  G. Ponnamperuma,et al.  Methods to Improve Diagnostic Reasoning in Undergraduate Medical Education in the Clinical Setting: a Systematic Review , 2021, Journal of General Internal Medicine.

[4]  S. Mamede,et al.  How cognitive psychology changed the face of medical education research , 2020, Advances in Health Sciences Education.

[5]  M. Endedijk,et al.  The process of slowing down in clinical reasoning during ultrasound consultations , 2020, Medical education.

[6]  Andrew S Parsons,et al.  The Management Script: A Practical Tool for Teaching Management Reasoning. , 2020, Academic medicine : journal of the Association of American Medical Colleges.

[7]  S. Yazdani,et al.  A novel model of clinical reasoning: cognitive zipper model , 2020, Journal of advances in medical education & professionalism.

[8]  N. Afonso,et al.  Evaluation of the effect of a new clinical reasoning curriculum in a pre-clerkship clinical skills course , 2020, Perspectives on Medical Education.

[9]  S. Schoenbaum,et al.  Competencies for improving diagnosis: an interprofessional framework for education and training in health care , 2019, Diagnosis.

[10]  Michelle Daniel,et al.  Clinical Reasoning Assessment Methods: A Scoping Review and Practical Guidance. , 2019, Academic medicine : journal of the Association of American Medical Colleges.

[11]  S. Ramani,et al.  Assessing Clinical Reasoning: Targeting the Higher Levels of the Pyramid , 2019, Journal of General Internal Medicine.

[12]  A. Mansoor Frameworks for Internal Medicine , 2018 .

[13]  Daniel J. Minter,et al.  Putting Schemas to the Test: An Exercise in Clinical Reasoning , 2018, Journal of General Internal Medicine.

[14]  René van Paassen,et al.  Dealing With Unexpected Events on the Flight Deck: A Conceptual Model of Startle and Surprise , 2017, Hum. Factors.

[15]  Denise M. Connor,et al.  When the Script Doesn’t Fit: An Exercise in Clinical Reasoning , 2017, Journal of General Internal Medicine.

[16]  J. Ely,et al.  Preventing Diagnostic Errors in Primary Care. , 2016, American family physician.

[17]  S. Lamba,et al.  Teaching Clinical Reasoning to Medical Students: A Case-Based Illness Script Worksheet Approach , 2016, MedEdPORTAL : the journal of teaching and learning resources.

[18]  K. Ericsson,et al.  Peak: Secrets from the New Science of Expertise , 2016 .

[19]  Erin Balogh,et al.  The Path to Improve Diagnosis and Reduce Diagnostic Error , 2015 .

[20]  E. Custers,et al.  Using script theory to cultivate illness script formation and clinical reasoning in health professions education , 2015, Canadian medical education journal.

[21]  M. Sibbald,et al.  Do research findings on schema-based instruction translate to the classroom? , 2015, Perspectives on Medical Education.

[22]  L. Young,et al.  Can Think Aloud Be Used to Teach and Assess Clinical Reasoning in Graduate Medical Education? , 2015, Journal of graduate medical education.

[23]  Jimmie Leppink,et al.  The evolution of cognitive load theory and its application to medical education , 2015, Perspectives on Medical Education.

[24]  J. Martín-Martín,et al.  Identification of factors associated with diagnostic error in primary care , 2014, BMC Family Practice.

[25]  R. Pinnock,et al.  Learning clinical reasoning , 2014, Journal of paediatrics and child health.

[26]  Robert McKinley,et al.  Teaching clinical reasoning to medical students , 2013, The clinical teacher.

[27]  Pat Croskerry,et al.  From mindless to mindful practice--cognitive bias and clinical decision making. , 2013, The New England journal of medicine.

[28]  Iztok Hozo,et al.  Dual processing model of medical decision-making , 2012, BMC Medical Informatics and Decision Making.

[29]  M. Sibbald,et al.  Should we teach using schemas? Evidence from a randomised trial , 2012, Medical education.

[30]  R. M. Vazquez The Checklist Manifesto How to Get Things Right , 2011 .

[31]  J. Kassirer Teaching clinical reasoning: case-based and coached. , 2010, Academic medicine : journal of the Association of American Medical Colleges.

[32]  M. Henderson,et al.  A 43-Year-Old Woman with Abdominal Pain and Fever , 2010, Journal of general internal medicine.

[33]  H. Markel Abraham Flexner and his remarkable report on medical education: a century later. , 2010, JAMA.

[34]  G. Dhaliwal,et al.  Doing What Comes Naturally , 2010, Journal of General Internal Medicine.

[35]  Pat Croskerry,et al.  A universal model of diagnostic reasoning. , 2009, Academic medicine : journal of the Association of American Medical Colleges.

[36]  Georges Bordage,et al.  Conceptual frameworks to illuminate and magnify , 2009, Medical education.

[37]  A. Kumagai A conceptual framework for the use of illness narratives in medical education. , 2008, Academic medicine : journal of the Association of American Medical Colleges.

[38]  Henk G Schmidt,et al.  How expertise develops in medicine: knowledge encapsulation and illness script formation , 2007, Medical education.

[39]  Vicki R Leblanc,et al.  Teaching from the clinical reasoning literature: combined reasoning strategies help novice diagnosticians overcome misleading information , 2007, Medical education.

[40]  Kevin W Eva,et al.  Knowing When to Look It Up: A New Conception of Self-Assessment Ability , 2007, Academic medicine : journal of the Association of American Medical Colleges.

[41]  J. Bowen Educational strategies to promote clinical diagnostic reasoning. , 2006, The New England journal of medicine.

[42]  H. Mandin,et al.  Using a conceptual framework during learning attenuates the loss of expert-type knowledge structure , 2006, BMC Medical Education.

[43]  Taryn Elliott,et al.  Expert Decision-Making in Naturalistic Environments: A Summary of Research , 2005 .

[44]  M. Offredy,et al.  The use of ‘think aloud’ technique, information processing theory and schema theory to explain decision-making processes of general practitioners and nurse practitioners using patient scenarios , 2005, Primary Health Care Research & Development.

[45]  M. Riedel Acute pulmonary embolism 2: treatment , 2001, Heart.

[46]  Richard J Adams,et al.  Introduction to cognitive processes of expert pilots. , 2000, Human performance in extreme environments : the journal of the Society for Human Performance in Extreme Environments.

[47]  R. Helmreich On error management: lessons from aviation , 2000, BMJ : British Medical Journal.

[48]  H P Boshuizen,et al.  Scripts and Medical Diagnostic Knowledge: Theory and Applications for Clinical Reasoning Instruction and Research , 2000, Academic medicine : journal of the Association of American Medical Colleges.

[49]  G. Regehr,et al.  Mental representations of medical diagnostic knowledge: a review , 1996, Academic medicine : journal of the Association of American Medical Colleges.

[50]  Asaf Degani,et al.  Cockpit Checklists: Concepts, Design, and Use , 1993 .

[51]  Leonard E Ross,et al.  Pilot’s Evaluation of the Usefulness of Full Mission IFR Simulator Flights for General Aviation Pilot Training , 1990 .

[52]  Richard C. Anderson,et al.  A Schema-Theoretic View of Basic Processes in Reading Comprehension. Technical Report No. 306. , 1988 .

[53]  W. Brewer,et al.  The nature and functions of schemas. , 1984 .

[54]  Gordon H. Bower,et al.  Memory for scripts with organized vs. randomized presentations , 1980 .

[55]  Paul E. Illman The pilot's handbook of aeronautical knowledge , 1979 .

[56]  G. Bower,et al.  Hierarchical retrieval schemes in recall of categorized word lists , 1969 .

[57]  J. Bowen,et al.  Prerequisites for Learning Clinical Reasoning , 2018 .

[58]  S. Durning,et al.  Principles and Practice of Case-based Clinical Reasoning Education: A Method for Preclinical Students , 2018 .

[59]  D. Sklar Teaching the Diagnostic Process as a Model to Improve Medical Education. , 2017, Academic medicine : journal of the Association of American Medical Colleges.

[60]  J. Hahn The Critique Of Pure Reason , 2016 .

[61]  M. Henderson,et al.  Diagnostic Scheming , 2015, Journal of General Internal Medicine.

[62]  Adam S. Cifu,et al.  Symptom to Diagnosis: An Evidence-Based Guide , 2006 .

[63]  T J Connolly,et al.  A simulator-based approach to training in aeronautical decision making. , 1989, Aviation, space, and environmental medicine.