Diagnostic strategies of fifth year medical students in a neurological case. The importance of the first hypothesis.
The problem-solving strategies of fifth year medical students were studied using two simulated cases. One of these cases involved a neurological problem which was unfamiliar to the students. With the use of stimulated recall the study looked at the origin of the first hypothesis. The symptoms given by the patient did not trigger an appropriate hierarchy of questions and the students resorted to problem-solving techniques, such as drawing on commonsense. In some cases they matched symptoms against clinical cases they had seen previously. Recall from lectures was used occasionally. Instead of rational methods of hypothesis generation, they were most likely to be influenced by recent clinical exposures. Students having identical experiences may have had differing perceptions of these exposures. As a result, their early hypothesis formation showed marked individual variation. These findings need to be considered in the light of how students learn and the content of the teaching that is meaningful to them.
Gibson
M
M
Office of the Clinical Dean, Prince Henry's Hospital, Melbourne, Victoria.
Kaaden
J
J
Balla
J I
JI
D003479:Curriculum; D003937:Diagnosis, Differential; D006801:Humans; D007396:Internship and Residency; D009422:Nervous System Diseases / Q000175:diagnosis*; D009462:Neurology / Q000193:education*