{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T23:23:16Z","timestamp":1792797796230,"version":"4.5.0"},"reference-count":25,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2020,3,17]],"date-time":"2020-03-17T00:00:00Z","timestamp":1584403200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"Flinders University Faculty of Medicine Small Grant","id":[{"id":"https:\/\/ror.org\/01kpzv902","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl J Lang & Comm Disor"],"published-print":{"date-parts":[[2020,7]]},"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n A clinical swallow examination (CSE) provides integral information that informs the diagnostic decision\u2010making process within dysphagia management. However, multiple studies have highlighted a high degree of reported variability within the CSE process. It has been hypothesized that such variability may be the result of the clinical reasoning process rather than poor practices.<\/jats:p>\n <\/jats:sec>\n \n Aims<\/jats:title>\n To elucidate the nature of expert, speech\u2013language therapists\u2019 (SLTs) clinical reasoning during an initial bedside assessment of patients referred for suspected dysphagia in the acute care environment.<\/jats:p>\n <\/jats:sec>\n \n Methods & Procedures<\/jats:title>\n An exploratory \u2018observation of practice\u2019 qualitative methodology was used to achieve the aim. Four expert SLTs, from two clinical services, completed CSEs with 10 new referrals for suspected dysphagia. All assessments were video\u2010recorded, and within 30 min of completing the CSE, a video\u2010stimulated \u2018think aloud\u2019 semi\u2010structured interview was conducted in which the SLT was prompted to articulate their clinical reasoning at each stage of the CSE. Three types of concept maps were generated based on this video and interview content: a descriptive concept map, a reasoning map and a hypothesis map. Patterns that consistently characterized the assessment process were identified, including the overall structure; types of reasoning (inductive versus deductive), facts (i.e., clinical information) drawn upon; and outcomes of the process (diagnosis and recommendations). Interview content was examined to identify types of expert reasoning strategies using during the CSE.<\/jats:p>\n <\/jats:sec>\n \n Outcomes & Results<\/jats:title>\n SLTs\u2019 approach to clinical assessment followed a consistent structure, with data gathered pre\u2010bedside, during the patient interview and direct assessment before a management recommendation was made. Within this structure, SLTs engaged in an iterative approach with inductive hypothesis\u2010generating and deductive hypothesis\u2010testing, with each decision\u2010making pathway individually tailored and informed by patient\u2010specific facts collected during the assessment. Clinical assessment was primarily geared towards management of an initial acute presentation with less focus on formulating a diagnostic statement.<\/jats:p>\n <\/jats:sec>\n \n Conclusions & Implications<\/jats:title>\n Variability in reported dysphagia practice is likely the result of a patient\u2010centred assessment process characterized by iterative cycles of fact\u2010gathering in order to generate and test clinical hypotheses. This has implications for the development of novel assessment tools, as well as professional development and education of novice SLTs.<\/jats:p>\n <\/jats:sec>\n \n \n \n \n \n What this paper adds<\/jats:title>\n \n What is already known on the subject<\/jats:title>\n \n \n \n CSE practices are reportedly variable, which has led to calls for more stringent, standardized assessment tools. Emerging evidence suggests that this variation is non\u2010random, but may arise from clinical reasoning processes.<\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:p>\n <\/jats:sec>\n \n What this paper adds to existing knowledge<\/jats:title>\n \n \n \n We directly observed expert SLTs conducting CSEs and identified patterns in practice that were consistent across all CSEs evaluated. These patterns were consistent in structure, whereas the content of the assessment items varied and was tailored to individual patient presentation. Overall, expert SLTs engaged in balanced cycles of inductive hypothesis generation and deductive hypothesis\u2010testing, a hallmark of good clinical assessment and practice.<\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:p>\n <\/jats:sec>\n \n What are the potential or actual clinical implications of this work?<\/jats:title>\n \n \n \n Ensuring quality CSE requires a more nuanced approach that considers the role of clinical reasoning in SLTs\u2019 decision\u2010making and the potential unintended negative consequences of standardized assessment tools.<\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:p>\n <\/jats:sec>\n <\/jats:sec>\n <\/jats:boxed-text>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/1460-6984.12531","type":"journal-article","created":{"date-parts":[[2020,3,18]],"date-time":"2020-03-18T01:44:40Z","timestamp":1584495880000},"page":"480-492","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Clinical reasoning and hypothesis generation in expert clinical swallowing examinations"],"prefix":"10.1111","volume":"55","author":[{"given":"Sue","family":"McAllister","sequence":"first","affiliation":[{"name":"Sydney School of Health Sciences The University of Sydney Sydney NSW Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helen","family":"Tedesco","sequence":"additional","affiliation":[{"name":"Southern Adelaide Local Health Network Adelaide SA Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samantha","family":"Kruger","sequence":"additional","affiliation":[{"name":"Southern Adelaide Local Health Network Adelaide SA Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth C.","family":"Ward","sequence":"additional","affiliation":[{"name":"The University of Queensland School of Health & Rehabilitation Sciences Brisbane QLD Australia"},{"name":"Centre for Functioning and Health Research Metro South Hospital and Health Services Brisbane QLD Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claire","family":"Marsh","sequence":"additional","affiliation":[{"name":"Speech Pathology, College of Nursing and Health Sciences Flinders University Adelaide SA Australia"},{"name":"Swallowing Neurorehabilitation Research Laboratory, Caring Futures Institute, College of Nursing and Health Sciences Flinders University Bedford Park SA Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6722-2666","authenticated-orcid":false,"given":"Sebastian H.","family":"Doeltgen","sequence":"additional","affiliation":[{"name":"Speech Pathology, College of Nursing and Health Sciences Flinders University Adelaide SA Australia"},{"name":"Swallowing Neurorehabilitation Research Laboratory, Caring Futures Institute, College of Nursing and Health Sciences Flinders University Bedford Park SA Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,3,17]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00455-006-9070-3"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1515\/ijnes-2014-0044"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2923.2003.01577.x"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/j.0022-0337.2004.68.12.tb03873.x"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/00001888-200308000-00003"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/ACM.0b013e3181ace703"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0039-1688814"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40141-018-0191-z"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.7205\/MILMED-D-12-00242"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1080\/10503307.2010.539284"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.nedt.2013.07.010"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1044\/1058-0360(2011\/10-0082)"},{"key":"e_1_2_11_14_1","volume-title":"Expertise of Family Physicians; Practical Experience, Knowledge and the Formation of Diagnostic Hypotheses","author":"Hobus P.","year":"1994"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/j.0022-0337.2012.76.9.tb05366.x"},{"issue":"1035","key":"e_1_2_11_16_1","article-title":"Critically appraising qualitative research","volume":"337","author":"Kuper A.","year":"2008","journal-title":"British Medical Journal"},{"key":"e_1_2_11_17_1","unstructured":"Marsh K. 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