title: Problem-solving strategies in psychiatry: differences between experts and novices in diagnostic accuracy and reasoning.
abstract: BACKGROUND
  The purpose of this study was to examine and compare diagnostic success and its relationship with the diagnostic reasoning process between novices and experts in psychiatry.
  
  
  METHODS
  Nine volunteers, comprising five expert psychiatrists and four clinical clerks, completed a think-aloud protocol while attempting to make a DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) diagnosis of a selected case with both Axis I and Axis III diagnoses.
  
  
  RESULTS
  Expert psychiatrists made significantly more successful diagnoses for both the primary psychiatric and medical diagnoses than clinical clerks. Expert psychiatrists also gave fewer differential options. Analyzing the think-aloud protocols, expert psychiatrists were much more organized, made fewer mistakes, and utilized significantly less time to access their knowledge than clinical clerks. Both novices and experts seemed to use the hypothetic-deductive and scheme-inductive approaches to diagnosis. However, experts utilized hypothetic-deductive approaches significantly more often than novices.
  
  
  CONCLUSIONS
  The hypothetic-deductive diagnostic strategy was utilized more than the scheme-inductive approach by both expert psychiatrists and clinical clerks. However, a specific relationship between diagnostic reasoning and diagnostic success could not be identified in this small pilot study. The author recommends a larger study that would include a detailed analysis of the think-aloud protocols.
authors.affiliation: Departments of Psychiatry, University of Calgary, Calgary, Canada ; Medical Education, Community Health Sciences, University of Calgary Calgary, Canada.
authors.forename: Adel
authors.initials: A
authors.lastname: Gabriel
authors.forename: Claudio
authors.initials: C
authors.lastname: Violato
keywords: diagnostic reasoning; hypothetic-deductive; knowledge structure; psychiatric diagnosis; scheme-inductive