The role of basic science knowledge and clinical knowledge in diagnostic reasoning: a structural equation modeling approach.
OBJECTIVE
To examine four theories on the role of basic science knowledge and clinical knowledge in diagnostic reasoning.


METHODS
In 2000-01, the authors tested the basic science and clinical knowledge and diagnostic performances of 59 family physicians and 184 second- to sixth-year medical students at Maastricht University, The Netherlands. Structural equation modeling was used to analyze the data. Four theoretical models were tested. In the first model only basic science knowledge is involved in diagnostic reasoning; in the second model only clinical knowledge is related to diagnostic reasoning; in the third model, clinical knowledge is related to diagnostic reasoning, but basic science knowledge is integrated in clinical knowledge; and in the fourth model, both basic science knowledge and clinical knowledge independently influence diagnostic reasoning.


RESULTS
Forty-four (75%) of the family physicians and 184 (100%) of the students responded. The results indicated that the third model, which is based on the knowledge encapsulation theory, provided the best fit to the data, whereas the models that had directly related basic science knowledge with diagnostic performance did not fit the data adequately.


CONCLUSIONS
The results generally supported the third model by Schmidt and Boshuizen of knowledge encapsulation theory suggesting that basic science knowledge is activated in expert diagnostic reasoning through its relation with clinical knowledge.
de Bruin
Anique B H
AB
Department of Psychology, WJ5-09, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands. debruin@fsw.eur.nl
Schmidt
Henk G
HG
Rikers
Remy M J P
RM
D002983:Clinical Competence / Q000706:statistics & numerical data*; D003071:Cognition; D003657:Decision Making; D003933:Diagnosis; D004504:Education, Medical, Undergraduate / Q000379:methods*; D004521:Educational Measurement; D006801:Humans; D007396:Internship and Residency / Q000592:standards / Q000706:statistics & numerical data*; D019359:Knowledge; D008962:Models, Theoretical; D009426:Netherlands; D010821:Physicians, Family / Q000193:education* / Q000523:psychology / Q000592:standards; D012586:Science / Q000193:education*; D013337:Students, Medical / Q000523:psychology / Q000706:statistics & numerical data*