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Diagnostic palpation and decision making: A neurocognitive model of expertise.

Journal: Russian Osteopathic Journal Date: 2014/06, 1-2(24-25):Pages: 92-109, type of study: article

Free full text   (https://www.academia.edu/7516306/Diagnostic_palpation_and_decision_making_A_neurocognitive_model_of_expertise)

Keywords:

clinical decision making [21]
osteopathy [460]
palpation [170]
palpatory findings [1]
reliability [114]
neurocognitive model [1]
diagnostic palpation [4]
article [2076]

Abstract:

Clinical decision making in osteopathy is heavily reliant on palpatory diagnostic findings. Although there is evidence that osteopathy is effective in the management of musculoskeletal conditions; the reliability of palpation as a diagnostic tool remains controversial. Research examining the reproducibility of diagnostic palpation consistently demonstrates that it lacks clinically acceptable levels of reliability. These findings might be explained by how individual perceptual judgments regarding the nature of the lesion or dysfunction are made and by the clinician’s level of professional expertise. Preliminary results from our research indicate that the development of expertise in diagnostic palpation is associated with changes in cognitive processing. Whereas the experts’ diagnostic judgments are heavily influenced by top-down, non-analytical processing; students rely primarily on bottom-up sensory processing from vision and haptics. Ongoing training and clinical practice are, arguably, likely to lead to changes in the osteopath’s neurocognitive architecture. This paper proposes a neurocognitive model of expertise in diagnostic palpation that has implications for osteopathic education and clinical practice. We argue that students and clinicians should be encouraged to appraise the reliability of different sensory cues in the context of clinical examination, combine sensory data from different channels, and consider using both analytical and non-analytical reasoning in their decision making. Importantly, they should develop their skills of criticality and their ability to reflect on, and analyse their practice experiences in and on action.


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