Diagnostic reasoning of high- and low-domain-knowledge clinicians: a reanalysis.
Thinking-aloud protocols provided by Joseph and Patel were reanalyzed to determine the extent to which their conclusions could be replicated by independently developed coding schemes. The data set consisted of protocols from four cardiologists (low domain knowledge = LDK) and four endocrinologists (high domain knowledge = HDK), individually working on a diagnostic problem in endocrinology. The two analyses agree that the HDK physicians related data to potential diagnoses more than did the LDK group and were more focused on the correct diagnostic components. However, the reanalysis found no meaningful difference between the groups in diagnostic accuracy, speed of diagnosis, or the breadth of the search space used to seek a solution. In the reanalysis, the HDK physicians employed more single-cue inference and less multiple-cue inference. The generalizability of results of protocol-analysis studies can be assessed by using several complementary coding schemes.
Elstein
A S
AS
Department of Medical Education, University of Illinois, Chicago 60680.
Kleinmuntz
B
B
Rabinowitz
M
M
McAuley
R
R
Murakami
J
J
Heckerling
P S
PS
Dod
J M
JM
D000368:Aged; D002983:Clinical Competence; D002985:Clinical Protocols; D003953:Diagnosis-Related Groups; D003951:Diagnostic Errors; D005260:Female; D006801:Humans; D007037:Hypothyroidism / Q000175:diagnosis*; D009230:Myxedema / Q000175:diagnosis*; D011340:Problem Solving; D013967:Thyroiditis, Autoimmune / Q000175:diagnosis*; D013997:Time Factors