title: Case representation by medical experts, intermediates and novices for laboratory data presented with or without a clinical context.
abstract: BACKGROUND
  Based on cognitive psychological research, a number of theoretical frameworks have been put forward to describe the structure of experts' medical knowledge and to explain experts' case-processing.
  
  
  OBJECTIVE
  To provide evidence for the theory of knowledge encapsulation, which states that medical knowledge constitutes of interlinked biomedical and clinical knowledge.
  
  
  METHODS
  Fourth-year medical students, clerks and medical experts evaluated six case descriptions, consisting of laboratory data either with or without a clinical context. For each case description, the participants were required to study the case, to formulate a diagnosis, and to write down everything they could remember of the case.
  
  
  RESULTS
  When the laboratory data were not embedded within a clinical context, medical experts' case-processing increased and their diagnostic accuracy became worse. Furthermore, laboratory data recall of medical experts was more elaborate in cases where the laboratory data were presented without a clinical context. Similar results were obtained for students and clerks.
  
  
  CONCLUSIONS
  The findings are only partially consistent with a prediction made by the theory of knowledge encapsulation. Further research, using a different paradigm than the traditionally used method of free recall, is required to unearth whether medical experts use qualitatively different knowledge structures than novices while solving cases.
authors.affiliation: Department of Psychology, Erasmus University of Rotterdam, PO Box 1738, NL-3000 DR Rotterdam, the Netherlands. verkoeijen@fsul.eur.nl
authors.forename: Peter P J L
authors.initials: PP
authors.lastname: Verkoeijen
authors.forename: Remy M J P
authors.initials: RM
authors.lastname: Rikers
authors.forename: Henk G
authors.initials: HG
authors.lastname: Schmidt
authors.forename: Margje W J
authors.initials: MW
authors.lastname: van de Wiel
authors.forename: Jeroen P
authors.initials: JP
authors.lastname: Kooman
mesh_terms: D002983:Clinical Competence / Q000592:standards; D019937:Diagnostic Techniques and Procedures / Q000592:standards*; D004501:Education, Medical / Q000379:methods; D006801:Humans; D008487:Medical History Taking / Q000592:standards*; D008606:Mental Processes; D011939:Mental Recall; D009426:Netherlands; D010821:Physicians, Family / Q000592:standards*; D011340:Problem Solving; D013337:Students, Medical