Scripts and clinical reasoning.
BACKGROUND
Each clinical encounter represents an amazing series of psychological events: perceiving the features of the situation; quickly accessing relevant hypotheses; checking for signs and symptoms that confirm or rule out competing hypotheses, and using related knowledge to guide appropriate investigations and treatment.


OBJECTIVE
Script theory, issued from cognitive psychology, provides explanations of how these events are mentally processed. This essay is aimed at clinical teachers who are interested in basic sciences of education. It describes the script concept and how it applies in medicine via the concept of the 'illness script'.


METHODS
Script theory asserts that, to give meaning to a new situation in our environment, we use goal-directed knowledge structures adapted to perform tasks efficiently. These integrated networks of prior knowledge lead to expectations, as well as to inferences and actions. Expectations and actions embedded in scripts allow subjects to make predictions about features that may or may not be encountered in a situation, to check these features in order to adequately interpret (classify) the situation, and to act appropriately.


CONCLUSIONS
Theory raises questions about how illness scripts develop and are refined with clinical experience. It also provides a framework to assist their acquisition.
Charlin
Bernard
B
Department of Surgery, University of Montreal, Montreal, Québec, Canada. bernard.charlin@umontreal.ca
Boshuizen
Henny P A
HP
Custers
Eugene J
EJ
Feltovich
Paul J
PJ
D000328:Adult; D002983:Clinical Competence; D003657:Decision Making; D003933:Diagnosis; D004504:Education, Medical, Undergraduate / Q000379:methods*; D006801:Humans; D019359:Knowledge; D013663:Teaching / Q000379:methods*