title: The role of pathophysiological explanations in clinical case representations of dental students and experts.
abstract: BACKGROUND
  Teaching of biomedical knowledge lays the foundations for the understanding and treatment of diseases. However, the representation of pathophysiological explanations in the management of clinical cases differs for various levels of medical expertise and different theories have been proposed to explain this phenomenon. The present study investigated for the first time how biomedical knowledge is used in clinical reasoning in dental medicine.
  
  
  METHODS
  In an experimental study 20 experts in the field of Periodontology and 61 students of different levels of training produced written pathophysiological explanations after having studied three different clinical cases. By comparing the written protocols to a visualised expert-made 'canonical' explanation the concepts used in the pathophysiological explanation were counted and classified as well as the links between concepts.
  
  
  RESULTS
  The statistical analysis by MANOVA showed significant differences between third- and fourth-year students, students of intermediate expertise level (fifth-year) and experts for various parameters qualifying concepts or links of the written pathophysiological explanations. The participants of intermediate expertise level produced a high rate of concepts and links; however, characteristic findings for knowledge encapsulation in the different levels of expertise were not evident. The analysis showed that the design of the clinical cases and of the canonical explanations significantly influenced the outcomes.
  
  
  CONCLUSIONS
  The present study demonstrated the pathophysiological representations of clinical cases in dental students and experts to be different from other medical disciplines. It could be assumed that this observation is based on different contents for teaching of practical skills and diagnostic procedures in dental compared with medical education.
authors.affiliation: Department of Surgery, Hannover Medical School, Hannover, Germany. hjklomp@chirurgie-sh.de
authors.forename: H J
authors.initials: HJ
authors.lastname: Klomp
authors.forename: J
authors.initials: J
authors.lastname: Eberhard
authors.forename: S
authors.initials: S
authors.lastname: Hren
authors.forename: J
authors.initials: J
authors.lastname: Hedderich
authors.forename: H G
authors.initials: HG
authors.lastname: Schmidt
mesh_terms: D010520:Aggressive Periodontitis / Q000209:etiology / Q000503:physiopathology; D003071:Cognition; D003210:Concept Formation; D003788:Dental Pulp Diseases / Q000209:etiology / Q000503:physiopathology; D003792:Dental Records; D004497:Education, Dental; D004522:Educational Status; D005179:Faculty, Dental; D005885:Gingival Hyperplasia / Q000139:chemically induced / Q000503:physiopathology; D006801:Humans; D010510:Periodontal Diseases / Q000209:etiology / Q000503:physiopathology*; D010517:Periodontics / Q000193:education*; D013335:Students, Dental; D013850:Thinking