Reasoning and Decision Making in Clinical Swallowing Examination

Sebastian H. Doeltgen, Flinders University
Sue McAllister, The University of Sydney
Joanne Murray, Flinders University
Elizabeth C. Ward, The University of Queensland
Jean E. Pretz, Elizabethtown College


Purpose of Review: Dysphagia has significant negative impact on health outcomes and hence evidence-based assessment and management of impaired swallowing is central to quality healthcare. Recent Findings: Approaches to the Clinical Swallowing Examination (CSE) vary considerably. It has been suggested that the patterns of item use within a CSE are non-random, and are influenced by the clinician’s decision making and reasoning processes relevant to each specific clinical scenario. These observations are in line with current models of diagnostic reasoning in the health professions and may reflect a dual process of analytical and intuitive decision making that allows clinical decisions to be made in situations of high cognitive load, limited resources, and dynamic workloads. As such, it may be the robustness of the clinical decision making process, not necessarily dogmatic adherence to item-based assessment protocols, that ensures quality CSE assessment processes, and ultimately, of the clinical care processes it informs. Summary: We provide an overview of the relevant literature on the cognitive psychology of human decision making and reasoning, and summarize existing research as it pertains to reasoning and decision making in the CSE. We draw connections between these exciting fields of research and offer our own considerations for future directions in research and scholarship in this area.