{
  "abstract": "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.\n\nConceptual 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.\n\nFramework: 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.\n\nImplications: 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.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Thoracic and Cardiovascular Surgery Heart and Diabetes Center NRW Ruhr University Bochum Bad Oeynhausen Nordrhein Westphalen Germany",
    "Clinic for Cardiology, Pulmonology, Angiology, and Intensive Care Medicine Marienkrankenhaus Hamburg Hamburg Germany",
    "Institute of Applied Mathematics Leibniz University Hannover Niedersachesen Germany",
    "III. Department of Medicine University Medical Center Hamburg‐Eppendorf Hamburg Hamburg Germany"
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 4,
  "authors": [
    {
      "affs": [
        0,
        1
      ],
      "name": "Yskert von Kodolitsch",
      "orcid": "0000-0001-5096-8421"
    },
    {
      "affs": [
        1
      ],
      "name": "Tilman Dreyer",
      "orcid": "0009-0007-6022-3731"
    },
    {
      "affs": [
        2
      ],
      "name": "Thomas Wick",
      "orcid": "0000-0002-1102-6332"
    },
    {
      "affs": [
        3
      ],
      "name": "Sigrid Harendza",
      "orcid": "0000-0002-7920-8431"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/a08er8ebh8dwy.bib",
  "cited_by": 0,
  "doi": "10.1111/jep.70709",
  "fulltext_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13730314/?tool=EBI",
  "id": "a08er8ebh8dwy",
  "issns": [
    "1356-1294",
    "1365-2753"
  ],
  "landing_url": "https://europepmc.org/article/PMC/PMC13730314",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Original Paper"
    ],
    [
      "openalex",
      "2714|Clinical Reasoning and Diagnostic Skills"
    ]
  ],
  "openalex": "W7225189979",
  "pdf_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13730314/pdf/?tool=EBI",
  "pmcid": "PMC13730314",
  "pmid": "42976113",
  "published": "2026-11-03",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/a08er8ebh8dwy.ris",
  "sources": [
    {
      "first_seen": "2026-11-04T15:20:46Z",
      "native_id": "PMC:PMC13730314",
      "source": "europepmc",
      "url": "https://europepmc.org/article/PMC/PMC13730314"
    },
    {
      "first_seen": "2026-11-07T12:22:53Z",
      "native_id": "PMC13730314",
      "source": "pmc",
      "url": "https://doi.org/10.1111/jep.70709"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2714|Clinical Reasoning and Diagnostic Skills",
      "subfield": "general"
    }
  ],
  "title": "From Static Choices to Navigating Clinical Trajectories: Reframing Therapeutic Reasoning in Medical Education",
  "title_text": "From Static Choices to Navigating Clinical Trajectories: Reframing Therapeutic Reasoning in Medical Education",
  "type": "peer-reviewed",
  "updated_at": "2026-11-07T12:22:53Z",
  "url": "https://research.draconitic.com/paper/a08er8ebh8dwy",
  "venue": "Journal of evaluation in clinical practice",
  "versions": []
}