Diagnostic thinking and information used in clinical decision-making: a qualitative study of expert and student dental clinicians.
BACKGROUND
It is uncertain whether the range and frequency of Diagnostic Thinking Processes (DTP) and pieces of information (concepts) involved in dental restorative treatment planning are different between students and expert clinicians.


METHODS
We video-recorded dental visits with one standardized patient. Clinicians were subsequently interviewed and their cognitive strategies explored using guide questions; interviews were also recorded. Both visit and interview were content-analyzed, following the Gale and Marsden model for clinical decision-making. Limited tests used to contrast data were t, chi2, and Fisher's. Scott's pi was used to determine inter-coder reliability.


RESULTS
Fifteen dentists and 17 senior dental students participated in visits lasting 32.0 minutes (+/- 12.9) among experts, and 29.9 +/- 7.1 among students; contact time with patient was 26.4 +/- 13.9 minutes (experts), and 22.2 +/- 7.5 (students). The time elapsed between the first and the last instances of the clinician looking in the mouth was similar between experts and students. Ninety eight types of pieces of information were used in combinations with 12 DTPs. The main differences found in DTP utilization had dentists conducting diagnostic interpretations of findings with sufficient certainty to be considered definitive twice as often as students. Students resorted more often to more general or clarifying enquiry in their search for information than dentists.


CONCLUSIONS
Differences in diagnostic strategies and concepts existed within clearly delimited types of cognitive processes; such processes were largely compatible with the analytic and (in particular) non-analytic approaches to clinical decision-making identified in the medical field. Because we were focused on a clinical presentation primarily made up of non-emergency treatment needs, use of other DTPs and concepts might occur when clinicians evaluate emergency treatment needs, complex rehabilitative cases, and/or medically compromised patients.
Maupomé
Gerardo
G
Department of Preventive and Community Dentistry, Indiana University School of Dentistry, Indianapolis, Indiana, USA. gmaupome@iupui.edu
Schrader
Stuart
S
Mannan
Saurabh
S
Garetto
Lawrence
L
Eggertsson
Hafsteinn
H
D016009:Chi-Square Distribution; D002983:Clinical Competence; D003210:Concept Formation; D003657:Decision Making; D003731:Dental Caries / Q000175:diagnosis; D003815:Dentists / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008960:Models, Psychological; D015588:Observer Variation; D016544:Patient Simulation; D036301:Qualitative Research; D011861:Radiography, Dental; D013335:Students, Dental / Q000523:psychology*; D014082:Tooth Fractures / Q000175:diagnosis
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