title: The difficulty with experience: does practice increase susceptibility to premature closure?
abstract: BACKGROUND
  A recent review of the physician performance literature concluded that the risk of prematurely closing one's diagnostic search increases with years of experience. To minimize confounding variables and gain insight into cognitive issues relevant to continuing education, the current study was performed to test this conclusion.
  
  
  METHODS
  Physician participants were shown a series of case histories and asked to judge the probability of a pair of diagnoses. The order in which features were presented was manipulated across participants and the probabilities compared to determine the impact of information order. Two groups of participants were recruited, 1 older than and 1 younger than 60 years.
  
  
  RESULTS
  The probability assigned to a diagnosis tended to be greater when features consistent with that diagnosis preceded those consistent with an alternative than when the same features followed those consistent with the alternative. Older participants revealed a greater primacy effect than less experienced participants across 4 experimental conditions.
  
  
  CONCLUSIONS
  Physicians with greater experience appear to weigh their first impressions more heavily than those with less experience. Educators should design instructional activities that account for experience-specific cognitive tendencies.
authors.affiliation: Department of Clinical Epidemiology and Biosta-tistics, Program for Educational Research and Development, McMaster University, Hamilton, Ontario, Canada. evakw@mcmaster.ca
authors.forename: Kevin W
authors.initials: KW
authors.lastname: Eva
authors.forename: John P W
authors.initials: JP
authors.lastname: Cunnington
mesh_terms: D000368:Aged; D000375:Aging; D002983:Clinical Competence; D003937:Diagnosis, Differential; D004502:Education, Medical, Continuing; D005194:Family Practice; D006801:Humans; D008875:Middle Aged