So, let's talk a little bit more now about the complexities of clinical reasoning. [BLANK_AUDIO]. The human mind does much to kind of put together thoughts and recognize patterns. And in fact, clinical reasoning is one of those complexities, and I believe it is multifaceted. And when we're talking about clinical reasoning, we're talking really about several different kinds of reasoning. There's the cognitive reasoning and the critical reasoning, which most of us are familiar with in terms of gathering information, inputing data, understanding terms. But then there's also the metacognitive reasoning, which is often times referred to as reflective reasoning, or thought taken to the second power, where you begin to think about your thinking. You become aware of being aware, and you begin to realize that you develop strategies and ways of going about mastering knowledge, skills, and abilities that become important to you as you self-regulate yourself in diff, different situations. And then, there is this notion about creative thinking and the nature of complementary pairs. So, for example you are always going to be in the, in the situation of developing and understanding what the opposite of a problem is. I think someone once said, life is bipolar, everything contains its opposite. So, when you're talking about pain as the problem, outcome, the outcome is really comfort, or pain control. If you're talking about anxiety, the outcome is really anxiety control. If you're talking about fear, the outcome is really fear control. And so thinking and understanding of the complementary nature, of both a problem and its outcome, becomes important. And that is the essence of creativity, a novel association that's useful in regards to looking at the complementary nature or the tension of opposites that exist between a problem and an outcome. And then there is this notion about systemic thinking, that there are balancing and reinforcing loops in a system dynamic. Patients don't just have one problem or one issue. They have competing problems and issues. And all of those are colliding and clustering at the same time. And so the opt model that we're going to talk about, and the clinical reasoning web, is a, is a strategy and a tool and a technique, for you to understand how that dynamic might work. It kind of gives you the balcony view of how all of these things relate to one another, and where you might find some leverage. Where's the center of gravity of this human system dynamic in terms of the problems that they have, and the outcomes that you want to evolve? And then, all of this of course, is about relationship dynamics and complexity thinking. And so, let's move on to thinking about clinical reasoning perspectives. And if you would, just stare at this necker cube of clinical reasoning for a minute, and tell me, or tell, imagine to yourself, what happens as you begin to put your gaze on that particular cube. For many people, the cube shifts. It's kind of an optical illusion. But the foreground becomes the background, and the background becomes the foreground. And so the complexity about clinical reasoning and reflection, and self regulated learning, and critical thinking and clinical judgement, as you begin to think about the assistant complexity thinking associated with clients stories and the issues and problems with which they struggle, it shifts sometimes foreground, background. And so your ability to kind of be aware of that, and pay attention to that, becomes important in terms of developing your clinical reasoning skills. So, I believe clinical reasoning has multiple logics associated with it. So there's the logic of the diagnosis, and that, is often times influence by your framing effects and your knowledge classification, or perhaps maybe your assessment tool. Then there's the logic of these competing diagnosis and outcomes; which we'll talk a little bit more about. And then there's the logic of the intervention, that will transfer, transition a patient from a current state to a desired state. And all of these logics you are managing at the same time, and so that each one contributes to your understanding in the development of the clinical reasoning skill set. And then there's the logic of the patterns of relationships between a problem, and outcome, and intervention. And then there's the logic of the clinical judgement associated with whether or not you have achieved the outcome that you want. And then there's the logic of managing yourself, in relationship to reasoning and thinking and your meta cognitive ability to reflect, and make sense of sometimes very complex and convoluted dynamics associated with patient conditions. All of this is in support of your building schemas in your brain, about patterns that you recognize. And as you increase your clinical experience, and as you see patients one after another you are building patterns and schemas about relationship dynamics, and so that in fact, you'll be able to recognize those patterns early on. And it will add to your intuition as well as your reasoning skills and abilities about multiple kinds of patient scenarios and situations. So OPT or opt the outcome present state test model of clinical reasoning is really a meta model for clinical reasoning. It's a model about a model in terms of clinical reasoning, and it has the following elements, listening and understanding a person's story; representation and framing, which we've already talked about; creating and activating a clinical reasoning web; appreciating the emergent relationships in a system dynamic; identification of a keystone issue; discerning the complementary nature of problems and outcomes; and understanding the five c's of clinical judgement. So here's the schema of the opt model. You can see in the far right here, we start with the client's story. And then we develop this clinical reasoning web of all the issues that, that client has suggested in relationship to their story, combined with the clinician's frame and knowledge representation system. And then we reflect about that in order to kind of find the center of gravity of the system dynamic, which becomes the present state keystone issue, which is then contrasted with the outcome state and the juxtaposition of a present state with an outcome state. Pain versus comfort creates the test that you want to build and transition in terms of moving the patient from a present state to a desired state, with the decisions and choices you make in terms of your intervention strategies. And that will lead you to a judgement. And the more judgements you make about multiple patient scenarios and case studies, you are more likely to develop schemas in regards to your understanding of the complexity of clinical reasoning around some of the chronic dilemma of pain management with patients. [SOUND] [BLANK_AUDIO]
