A failure to reproduce the intermediate effect in clinical case recall.
OBJECTIVE
To investigate the differences between experts, intermediates, and novices in diagnosing and representing clinical cases under various time constraints.


METHODS
Second-, fourth-, and sixth-year medical students, and internists studied, diagnosed, and recalled four clinical cases from internal medicine. Participants were allowed to study each case for either 3 minutes, 1 minute 15 seconds, or 30 seconds. The study replicated in most ways the 1993 clinical case recall study of Schmidt and Boshuizen.


RESULTS
As expected, diagnostic accuracy increased with level of expertise. However, this study failed to disclose the intermediate effect in clinical case recall that was found in the original study. Instead, a positive linear relation between expertise level and case recall was found. The discrepancy resulted from more elaborate recall by experts in the present study. Constraining processing time did not effect diagnostic accuracy, but equally affected the recall performances of the participants of all expertise levels. This contrasts with the earlier finding that experts' recall is independent of processing time.


CONCLUSIONS
Although it is unclear why the experts' case processing was more elaborate in the present study than in the earlier study, it must be concluded that expert medical knowledge is so flexibly organized that experts can easily represent clinical cases in either the encapsulated or the elaborated mode.
van de Wiel
M W
MW
Skillslab, Faculty of Medicine, Maastricht University, Maastricht, The Netherlands. m.vandewiel@educ.unimaas.nl
Schmidt
H G
HG
Boshuizen
H P
HP
D000368:Aged; D000704:Analysis of Variance; D001161:Arteriosclerosis / Q000175:diagnosis; D002983:Clinical Competence; D003951:Diagnostic Errors / Q000706:statistics & numerical data*; D006333:Heart Failure / Q000175:diagnosis; D006801:Humans; D007396:Internship and Residency; D008103:Liver Cirrhosis / Q000175:diagnosis; D008297:Male; D011939:Mental Recall; D009426:Netherlands; D010673:Pheochromocytoma / Q000175:diagnosis; D013274:Stomach Neoplasms / Q000175:diagnosis; D013337:Students, Medical; D013997:Time Factors