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Title: Osteopathic clinical reasoning : an ethnographic study of perceptual diagnostic judgments, metacognition, and reflective practice
Author: McIntyre, Cindy L.
ISNI:       0000 0004 5994 134X
Awarding Body: University of Bedfordshire
Current Institution: University of Bedfordshire
Date of Award: 2016
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This thesis explores the use of reflective practice in osteopathic medicine and uses the method to narrate my work as an osteopathic practitioner. It explores the development of perceptual diagnostic judgments, and the role of metacognition, intuition and palpation in osteopathic clinical reasoning. A qualitative interpretive approach was used with a novel narrative method as an organising structure. This was broadly based around reflective practice models of Gibbs, (1988), Kolb, (1984) and Carper (1978) and the ideas of Schön (1983). Descriptive texts were constructed from notes taken of my thoughts whilst in the presence of patients. This allowed access, as closely as possible, to my decision making process. Finally, the descriptive texts were expanded into narratives through dialogue with the existing literature and peer review. The narratives were then analysed using thematic analysis to derive an understanding of concepts arising from the data. This thesis argues that osteopathic clinical reasoning involves multisensory perceptual diagnostic judgments that begin as soon as the patient enters the clinic, and arise as a result of the use of mental and visual imagery and embodied senses. The multisensory information that is detected by a practitioner activates pattern recognition, analytic reasoning and provides explicit feedback used in decision making. Diagnosis occurs as a result of piecing together and interpreting the multisensory information whilst maintaining awareness of other diagnostic possibilities. The findings also suggest that osteopathic clinical reasoning involves the supervision of cognition by the metacognitive processes of meta-knowledge (MK), meta-experiences (ME), and meta-skills (MS). The latter are used to plan, monitor, analyse, predict, evaluate and revise the consultation and patient management as suggested by Pesut and Herman (1992). ME is demonstrated by the presence of judgments of learning used to ensure sufficient information has been gathered, and feelings of rightness that are used to perceive the correctness of information arriving and decisions made. The use of reflective practice in this research has developed the understanding of osteopathic clinical reasoning, and demonstrated that it provides a powerful conduit for change in practice. As a result, it enables the provision of better patient-centred osteopathic healthcare incorporating the biopsychosocial model of healthcare. Although rooted in my own osteopathic practice style and strategies, it should have resonance for those within the discipline of osteopathy and has implications for osteopathic education, training and research.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Prof.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: osteopathy ; ethnography ; metacognition ; reflective practice ; G750 Cognitive Modelling ; systemic practice