Diagnostic Reasoning of High - and Low - domain-knowledge Clinicians

Abstract

Thinking-aloud protocols provided by Joseph and Patel were reanalyzed to determine the extent to which their conclusions could be replicated by independently developed coding schemes. The data set consisted of protocols from four cardiologists (low domain knowledge = LDK) and four endocrinologists (high domain knowledge = HDK), individually working on a diagnostic problem in endocrinology. The two analyses agree that the HDK physicians related data to potential diagnoses more than did the LDK group and were more focused on the correct diagnostic components. However, the reanalysis found no meaningful difference between the groups in diagnostic accuracy, speed of diagnosis, or the breadth of the search space used to seek a solution. In the reanalysis, the HDK physicians employed more single-cue inference and less multiple-cue inference. The generalizability of results of protocol-analysis studies can be assessed by using several complementary coding schemes.

Nurse practitioners versus doctors diagnostic reasoning in a complex case presentation to an acute tertiary hospital: A comparative study

“…The audiotaped case scenario think aloud data were transcribed verbatim and analysed using coding and categorising described by Elstein et al (1993). Elstein et al developed and applied coding schemes to Joseph and Patel's (1990) study assessing the diagnostic accuracy of endocrinologists and cardiologists when analysing an endocrine case presentation (Joseph and Patel, 1990 Although think aloud is a qualitative method providing qualitative data, the qualitative data obtained from the think aloud transcriptions were transformed into quantitative data; this process is referred to as quantitising (Bazeley, 2009;Cresswell and Plano Clarke, 2011;Sandelowski, 2000).…”

“…The term diagnosis denotes labelling of the disease or illness and the term problem means abnormal findings or problems needing intervention (Brykczynski, 1989(Brykczynski, , 1999Elstein et al, 1993;Frauman and Skelly, 1999;Hoffman et al, 2009;Muller-Staub et al, 2008). The term action plan refers to applying interventions, prescribing and referring in response to identified diagnoses and problems (Baid, 2006;Carneiro, 2003;Weiss, 2011).…”

Use of forward versus backward reasoning during audit analytical procedures: evidence from a computerised‐process‐tracing field study

“…Results from the present study suggest that future research should explore auditor judgement with a theoretical framework that recognises the potential for using forward reasoning during analytical procedures. Accounting for the type of reasoning used to make decisions is important because forward and backward reasoning are influenced differently by individuallevel and task-level variables (Elstein et al , 1993). At the individual level, forward reasoning requires strategic knowledge about how to learn enough about the situation to make accurate diagnostic inferences but backward reasoning requires relational knowledge about the conditions or symptoms associated with different problems (Clancy, 1988).…”

“…Although physicians will generally rely on backward reasoning when they encounter uncommon symptoms, they will often rely heavily, if not exclusively on forward reasoning when symptoms are familiar (Elstein et al , 1990). As a consequence, the primary focus of clinical diagnosis research has shifted toward studies that examine how domain knowledge interacts with task structure to influence forward reasoning (Elstein et al , 1993).…”

Survey of physician practices for community-dwelling agitated dementia patients

“…For example, they may prescribe neuroleptics for all forms of agitation. In contrast, physicians who are more familiar with managing ADPs, either by clinical experience or by training, may make decisions that are qualitatively different from those made by less experienced physicians (expert-novice paradigm) (Grosswald, 1992;Elstein et al, 1993). As such, experts in managing ADPs might be expected to recommend treatment strategies that include medication options other than neuroleptics, as well as behavioral and psychosocial interventions.…”