Evidence base of clinical diagnosis: Clinical problem solving and diagnostic decision making: selective review of the cognitive literature

Elstein, Arthur S.; Schwarz, Alan

doi:10.1136/bmj.324.7339.729

Cited by 571 publications

(405 citation statements)

References 19 publications

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“…According to the students analytic as well as non-analytic reasoning strategies were being developed. Experts have been shown to use both types of reasoning, either separately or in combination, when addressing clinical problems (Eva 2005;Norman and Brooks 1997;Elstein and Schwarz 2002;Bowen 2006). Novices on the other hand have been found to use analytic reasoning strategies in favour of non-analytic strategies because they do not have enough experiential knowledge (Bowen 2006).…”

Section: Conclusion and Discussionmentioning

confidence: 99%

Students’ opinions about the effects of preclinical patient contacts on their learning

Diemers

Dolmans

Verwijnen

et al. 2007

Adv in Health Sci Educ

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Several reasons have been given why students should have contacts with real patients early in the undergraduate medical curriculum, i.e., in the preclinical phase. However, it is not clear exactly what effects early patient contacts have with regard to knowledge construction and the development of clinical reasoning skills. We sought students' views of the effects of preclinical real patient contacts on their learning, knowledge construction and development of clinical reasoning. Twenty-four students in the third and last preclinical year of a 6-year undergraduate medical programme were divided into three focus groups which met twice, after which saturation was reached. The discussions were recorded and transcribed. Summaries of the discussions were approved by the students after some modifications. Atlas-ti software was used to create a coding framework resulting in identification of main themes and sub themes. Early patient contacts motivate students to study, help them understand the impact of illness on patients' lives, and enhance professional socialisation and memory processes. Students distinguish between analytic and non-analytic clinical reasoning in connection with real patients. Analytic reasoning involves clinical and basic science knowledge. Non-analytic reasoning involves pattern recognition and is made possible by experiential learning from different patient contacts. The students indicate that seeing real patients early in their training has several positive effects on their learning. The contacts enhance knowledge construction and 123Adv in Health Sci Educ (2008) 13:633-647 DOI 10.1007 clinical reasoning. Although our results will have to be validated by quantitative, observational and experimental research, they imply that educational benefits are to be gained from real patient contacts in the preclinical phase of medical education.

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Section: Conclusion and Discussionmentioning

confidence: 99%

Students’ opinions about the effects of preclinical patient contacts on their learning

Diemers

Dolmans

Verwijnen

et al. 2007

Adv in Health Sci Educ

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“…Moreover, the model anticipates that an important component of deliberative categorization will be information search or hypothesis testing: Cases in which the data do not allow for a fast and confident determination of the correct hypothesis may require the decision maker to search for new information to discriminate among the set of potential hypotheses. Deliberative categorization processes of these sorts characterize expert physicians' generation and use of differential hypotheses in many diagnostic tasks (Elstein & Schwarz, 2002). In sum, HyGene can be considered a general model of judgment that describes both the processes of categorization (as well as category, or hypothesis, generation) and how the processes involved in categorization can affect probability judgment and information search.…”

Section: Hygene As a General Model Of Human Judgmentmentioning

confidence: 99%

“…The generation of new diagnoses may, in turn, lead to fresh information-search threads where new hypotheses might be brought to mind. At some point, either the search space is exhausted, the clinician continually fails to generate additional plausible hypotheses, or one particular hypothesis gains enough evidential support that the clinician can render a diagnosis with confidence (Elstein & Schwarz, 2002).…”

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confidence: 99%

Diagnostic hypothesis generation and human judgment.

Thomas

Dougherty

Sprenger

et al. 2008

Psychological Review

187

205

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Diagnostic hypothesis-generation processes are ubiquitous in human reasoning. For example, clinicians generate disease hypotheses to explain symptoms and help guide treatment, auditors generate hypotheses for identifying sources of accounting errors, and laypeople generate hypotheses to explain patterns of information (i.e., data) in the environment. The authors introduce a general model of human judgment aimed at describing how people generate hypotheses from memory and how these hypotheses serve as the basis of probability judgment and hypothesis testing. In 3 simulation studies, the authors illustrate the properties of the model, as well as its applicability to explaining several common findings in judgment and decision making, including how errors and biases in hypothesis generation can cascade into errors and biases in judgment.

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“…Thus, clinicians may tend to overestimate the frequency of vivid, or easily recalled events and underestimate the likelihood of events that are ordinary, or difficult to recall. Elstein and Schwarz (2002) proposed that availability heuristics may contribute to the overemphasis of rare conditions, as rare cases may be more memorable. Alternatively, rare diagnoses may be missed because the category and its criteria may not be easily remembered, or the clinician has received little training or encountered few instances of the diagnosis.…”

Section: Diagnostic Decision-makingmentioning

confidence: 99%

Diagnosis of depersonalization disorder

DeHoff¹

2011

PsycEXTRA Dataset

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Depersonalization Disorder (DPD) is considered both under-researched and underdiagnosed. A variety of reasons have been proposed for the under-diagnosis of DPD, including the high frequency of depersonalization as a symptom and comorbidity of DPD with other disorders. Under-diagnosis of DPD has also been attributed to inadequate diagnostic criteria in the DSM-IV-TR, as it lists only four criteria and only one specifically addresses the phenomenon of depersonalization. Several groups of researchers have proposed more comprehensive and in-depth conceptualizations of DPD. Further, common biases in clinical decision-making, such as an over-reliance on cognitive heuristics and the use of prototypes, can contribute to inaccurate diagnosis and under-diagnosis. A national sample of licensed psychologists was randomly selected and recruited from the membership of the American Psychological Association. The study was conducted on-line and participants were asked to read one of two DPD cases, assign a diagnosis, and rate the representativeness of a series of diagnoses for the case. They were also asked to rate the presence of a list of symptoms, including the DSM-IV-TR and ICD-10 criteria for DPD, and the symptoms and dimensions of DPD and depersonalization from the literature. Half of the participants were asked to assign a diagnosis and then rate symptoms (simulated prototype approach) while the others rated the symptoms before assigning a diagnosis (simulated DSM-IV approach). The study found that clinicians under-diagnosed DPD and that the DSM-IV depersonalization criterion had high sensitivity but not adequate specificity. Results indicated that a simulated DSM-IV approach

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Evidence base of clinical diagnosis: Clinical problem solving and diagnostic decision making: selective review of the cognitive literature

Cited by 571 publications

References 19 publications

Students’ opinions about the effects of preclinical patient contacts on their learning

Students’ opinions about the effects of preclinical patient contacts on their learning

Diagnostic hypothesis generation and human judgment.

Diagnosis of depersonalization disorder

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