Adapting advances in medical clinical reasoning for the continuous learning and application of methods and procedures for holistic building pathology

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Hutton, T, 2025. Adapting advances in medical clinical reasoning for the continuous learning and application of methods and procedures for holistic building pathology. PhD, Nottingham Trent University.

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Abstract

Purpose

Buildings are crucial for the survival of individuals and cultures, making the investigation and remediation of failures in the built environment essential, especially in a rapidly changing world and under the stress of climate change. Building Pathology, a relatively new subject, involves a holistic approach to diagnosing and addressing failures in buildings, viewing them as complex systems that evolve over time. However, since its inception in the 1980s, the understanding and application of Building Pathology has remained underdeveloped. This research tests the hypothesis that Building Pathology can be treated as a parallel to Medical Pathology, allowing the adaptation of recent advances in Medical Clinical Reasoning to improve the learning and application of holistic Building Pathology.

Research Methodology

This research, aiming to establish a holistic foundation for Building Pathology, began with a review of literature exploring the evolution of buildings as biologically generated systems and the origins of building pathologies. It draws parallels with medical pathology to support the hypothesis that these fields share similarities.

Building Pathology, which emerged in the 1980s, was further reviewed through literature and pilot interviews with experts. A key constraint identified was the lack of a holistic, evolutionary approach to the field, including the importance of case histories. To address this, methods for teaching and applying a holistic approach to Building Pathology were proposed, based on the researcher’s 40 years of experience and recent advancements in clinical reasoning in medical pathology.

To support the research, current teaching practices in Building Pathology in the UK were compared to those in Clinical Reasoning, using semi-structured interviews with educators. Methods for diagnosing damp problems, a representative subset of Building Pathology, were developed through action research, informed by both the researcher’s experience and developments in medical clinical reasoning.

Finally, Script Concordance Tests were created to teach and assess the metacognitive processes involved in diagnosing damp problems, based on best practices in medical clinical reasoning. These tests were beta-tested with experts and students, demonstrating the potential for parallel processes in learning and applying diagnoses in both fields.

Findings

This research presents key findings that advance the field of Building Pathology. It identifies the evolution of buildings and their associated pathologies, showing how these issues develop over time. The study also analyses barriers to the growth of Building Pathology as both a practical discipline and academic subject, including the lack of holistic understanding and approaches in training and practice.

A major contribution is the identification of parallels between Building Pathology and Medical Clinical Reasoning, suggesting that medical diagnostic principles can be applied to building failures. This comparison provides a framework for continuous learning in diagnosing and treating building pathologies.

The research also develops a comprehensive system for applying and continuously learning Holistic Building Pathology, integrating diagnostic tools to support both initial assessments and ongoing education, essential for addressing evolving challenges in the built environment.

The study further evaluates current best practices for teaching Building Pathology in the UK, identifying gaps in existing programs and highlighting the need for more structured, case based, and holistic approaches. Additionally, the research creates metacognitive tools and frameworks to address "damp problems," a key subset within Building Pathology, improving diagnostic accuracy and decision-making.

Lastly, the research validates Script Concordance Tests (SCTs) as an effective method for assessing clinical reasoning in Building Pathology, ensuring practitioners have the necessary skills for accurate diagnosis and remediation.

Originality

The ‘new, original contributions to knowledge’ arising from this work is that Building Pathology and Medical Pathology are not just analogous but are similar and parallel subjects, and that recent advances in the teaching and continuous learning in the subject of Medical Clinical Reasoning can therefore be used to facilitate the continuous learning and application of the subject of Building Pathology. This research is also the first recorded use of Script Concordance Tests outside of education and certification in the medical professions, which serves as a practical illustration of a number of the theoretical aspects explored as part of this Thesis

Item Type:	Thesis
Creators:	Hutton, T.
Contributors:	Name Role NTU ID ORCID Sagoo, A. Thesis supervisor CON3SAGOOA https://orcid.org/0000-0002-9969-0771 Coffey, C. Thesis supervisor BLG3COFFECM UNSPECIFIED Remedios, R. Thesis supervisor PSY3REMEDR https://orcid.org/0000-0002-7717-6421
Date:	January 2025
Rights:	The right of Timothy Charles Hutton to be identified as the author of this work is asserted in accordance with ss.77 and 78 of the Copyright, Designs and Patents Act 1988. At this date copyright is owned by the author.
Divisions:	Schools > School of Architecture, Design and the Built Environment
Record created by:	Jeremy Silvester
Date Added:	25 Apr 2025 14:32
Last Modified:	25 Apr 2025 14:32
URI:	https://irep.ntu.ac.uk/id/eprint/53459