Clinical case processing: a diagnostic versus a management focus.
BACKGROUND
Most studies on medical expertise research have focused on diagnostic performance, whereas patient management has been largely ignored. According to knowledge encapsulation theory, applying encapsulated knowledge is a characteristic of expert doctors' diagnostic reasoning, but it is unclear whether or not encapsulated knowledge also plays a prominent role when processing a clinical case with a management focus.


METHODS
The participants were 40 medical students (20 in Year 4 and 20 in Year 6) and 20 expert doctors (internists). Participants were asked to study the cases with either a diagnostic (Dx) or a management (Mx) focus. Subsequently, participants were asked to write down what they remembered from the case.


RESULTS
In both conditions, experts recalled fewer propositions and used more high-level inferences than medical students. Furthermore, they processed the cases faster and more accurately than medical students, but no significant difference between Mx and Dx conditions was found. Year 4 students also showed no significant differences in recall and processing speed between conditions. By contrast, Year 6 students recalled more in a Dx than in an Mx condition, but there was no significant difference in processing speed between conditions.


CONCLUSIONS
In both conditions, findings indicate that the experts' and Year 4 students' performance was not affected by processing focus. The fact that only Year 6 students were affected by processing focus might be explained by the assumption that their diagnostic knowledge and management knowledge are not fully integrated yet, a process that has already taken place in the expert's knowledge structure.
Monajemi
Alireza
A
Applied Physiology Research Centre, Isfahan University of Medical Sciences, Isfahan, Iran. Alirezamonajemi@yahoo.com
Rikers
Remy M J P
RM
Schmidt
Henk G
HG
D002983:Clinical Competence; D003933:Diagnosis; D004504:Education, Medical, Undergraduate / Q000379:methods*; D006801:Humans; D007396:Internship and Residency / Q000379:methods*; D011939:Mental Recall; D010346:Patient Care Management; D010820:Physicians / Q000523:psychology* / Q000592:standards; D013337:Students, Medical / Q000523:psychology*