An Investigation of How Clinicians use Anatomical Knowledge in Diagnostic Reasoning: A Grounded Theory Study of Clinicians in Zambia

Background: The role of biomedical sciences in diagnostic reasoning is contentious but diagnostic reasoning is a principal activity in clinical settings. Such ambiguity creates a tension for medical educators who use clinically oriented anatomy teaching. Purposes: The aim of this paper is to contribute to the debate in the literature via a novel grounded theory about use of anatomy in diagnostic reasoning. Methods: Systematic grounded theory procedures were used to collect data using forty-six weeks-long participant observations, self-administered questionnaires from 168 respondents (140 doctors and 28 medical students at UTH), and unstructured interviews with doctors working in hospitals. Results: Use of anatomy in diagnostic reasoning is a 5-stage cognitive process: patient information data gathering; ascribing the information gathered to anatomical descriptors; interpretation; anatomical representation of the clinical circumstances; and diagnosis. Conclusion: Use of anatomy in diagnostic reasoning is a 5-stage cognitive process: patient information data gathering; ascribing the information gathered to anatomical descriptors; interpretation; anatomical representation of the clinical circumstances; and diagnosis. The conceptual model presented provides a framework for future research and comparison with existing theories.