From Static Choices to Navigating Clinical Trajectories: Reframing Therapeutic Reasoning in Medical Education
4 affiliations
- 1Department of Thoracic and Cardiovascular Surgery Heart and Diabetes Center NRW Ruhr University Bochum Bad Oeynhausen Nordrhein Westphalen Germany
- 2Clinic for Cardiology, Pulmonology, Angiology, and Intensive Care Medicine Marienkrankenhaus Hamburg Hamburg Germany
- 3Institute of Applied Mathematics Leibniz University Hannover Niedersachesen Germany
- 4III. Department of Medicine University Medical Center Hamburg‐Eppendorf Hamburg Hamburg Germany
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.
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.
Related
- Information theory and diagnostic reasoning in primary care: a framework for navigating uncertainty.
- Navigating emergency medicaid and securing long-term medicaid coverage- patient education series: understanding trauma and emergency surgery conditions.
- Reframing Validity: How Values Shape Assessment in Postgraduate Medical Education
- Preserving Clinical Reasoning in ChatGPT-Integrated Medical Education: From AI Use to Cognitive Engagement.
- Integrating AI-Assisted World Café Discussion Into Clinical Reasoning Training: an Exploratory Study in Medical Education
BibTeX
@article{kodolitsch2026from,
title = {{From Static Choices to Navigating Clinical Trajectories: Reframing Therapeutic Reasoning in Medical Education}},
author = {Yskert von Kodolitsch and Tilman Dreyer and Thomas Wick and Sigrid Harendza},
journal = {Journal of evaluation in clinical practice},
year = {2026},
month = nov,
doi = {10.1111/jep.70709},
url = {https://europepmc.org/article/PMC/PMC13730314},
note = {CC BY},
}
RIS
TY - JOUR
TI - From Static Choices to Navigating Clinical Trajectories: Reframing Therapeutic Reasoning in Medical Education
AU - Yskert von Kodolitsch
AU - Tilman Dreyer
AU - Thomas Wick
AU - Sigrid Harendza
PY - 2026
DA - 2026/11/03
JO - Journal of evaluation in clinical practice
DO - 10.1111/jep.70709
UR - https://europepmc.org/article/PMC/PMC13730314
AB - 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.
SN - 1356-1294
SN - 1365-2753
ER -