TY - JOUR
T1 - Cognitive aspects of clinical performance during patient workup
T2 - The role of medical expertise
AU - Patel, Vimla L.
AU - Groen, Guy J.
AU - Patel, Yogesh C.
N1 - Funding Information:
This research was supported in part by a grant from the Social Sciences and Humanities Research Council of Canada (410-92-1535) to the first author.
PY - 1997
Y1 - 1997
N2 - This paper examines the role of medical expertise in clinical reasoning, using a complete workup of a patient with an endocrine disorder. Endocrinologists, housestaff, and final year medical students were asked to develop the case. This consisted of history-taking, interpreting physical examination results, request for tests and their interpretations, and providing therapeutic and patient management plans, and an explanation of the pathophysiology underlying the problem. The subjects were also asked to provide explanations supporting their decisions during the patient workup. A variety of techniques deriving from cognitive psychology were used to analyze the data. The main concern was how expertise affected the building of relationship between the components of the workup. Experts formed integrated knowledge-rich structures that were generated during the history-taking and used consistently throughout the workup. Housestaff formed more tentative and less integrated representations which were modified during the patient encounter. Students representations superficially resembled those of experts, but were knowledge-lean. The results are interpreted in terms of clinical performance of endocrinologists, housestaff, and students during the workup, and its relationship to the explanation task as an indicator of clinical competence of the patient problem provided by the subjects. It is proposed that the explanation given after the problem solving process could be used as an indicator of clinical competence.
AB - This paper examines the role of medical expertise in clinical reasoning, using a complete workup of a patient with an endocrine disorder. Endocrinologists, housestaff, and final year medical students were asked to develop the case. This consisted of history-taking, interpreting physical examination results, request for tests and their interpretations, and providing therapeutic and patient management plans, and an explanation of the pathophysiology underlying the problem. The subjects were also asked to provide explanations supporting their decisions during the patient workup. A variety of techniques deriving from cognitive psychology were used to analyze the data. The main concern was how expertise affected the building of relationship between the components of the workup. Experts formed integrated knowledge-rich structures that were generated during the history-taking and used consistently throughout the workup. Housestaff formed more tentative and less integrated representations which were modified during the patient encounter. Students representations superficially resembled those of experts, but were knowledge-lean. The results are interpreted in terms of clinical performance of endocrinologists, housestaff, and students during the workup, and its relationship to the explanation task as an indicator of clinical competence of the patient problem provided by the subjects. It is proposed that the explanation given after the problem solving process could be used as an indicator of clinical competence.
KW - Clinical competence
KW - Data-driven reasoning
KW - Diagnostic problem solving
KW - Doctor-patient interaction
KW - Explanation
KW - Hypothesis-driven reasoning
KW - Medical cognition
KW - Medical expertise
KW - Patient workup
KW - Therapeutic decision making
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U2 - 10.1023/A:1009788531273
DO - 10.1023/A:1009788531273
M3 - Article
AN - SCOPUS:26444517867
SN - 1382-4996
VL - 2
SP - 95
EP - 114
JO - Advances in Health Sciences Education
JF - Advances in Health Sciences Education
IS - 2
ER -