From Static Choices to Navigating Clinical Trajectories: Reframing Therapeutic Reasoning in Medical Education
Yskert von Kodolitsch, Tilman Dreyer, Thomas Wick, Sigrid HarendzaABSTRACT
Problem
Therapeutic reasoning is central to clinical practice and informed by established frameworks such as evidence‐based medicine and shared decision‐making. In educational settings, however, therapeutic decision‐making is frequently taught and assessed as a discrete choice among predefined treatment options. This static framing – commonly structured through decision trees and guideline algorithms– emphasizes treatment selection under uncertainty but may insufficiently reflect the temporally evolving and regulatory nature of patient care.
Conceptual Shift
We propose that therapeutic reasoning can be more fully understood as the navigation of clinical trajectories rather than the selection of isolated choices. Drawing on complex adaptive systems theory, we conceptualize disease, resilience, and health as dynamically interacting functions evolving through feedback loops and shifting stability. Therapeutic reasoning is the anticipatory and interpretive process that guides the adaptive regulation of evolving clinical trajectories across coupled systems of organism and pathology. This perspective complements established decision‐making models by making the temporal and systemic dimensions of therapeutic practice explicit.
Framework
We operationalize this reframing through a phase‐based model distinguishing disease‐dominant decline, therapy‐dominant modulation, and resilience‐dominant recovery. Using severe pneumonia as an illustrative case, we demonstrate how inflection points and destabilizing events reveal the dynamic cognitive work underlying therapeutic practice and provide a conceptual scaffold for structuring therapeutic thinking.
Implications
Reframing therapeutic reasoning as trajectory navigation enriches the teaching of therapeutic decision making by providing a conceptual scaffold for curriculum design, clinical supervision, and assessment.