Problem Solving: Applications of Research to Undergraduate Instruction and Evaluation

Abstract

The formal reasoning strategy used in medical diagnostic problem solving can be conceptualised as composed of four more elementary processes -cue acquisition, hypothesis generation, cue interpretation and hypothesis evaluation. These processes are closely linked to the clinician's store of medical knowledge. The acquisition, retention and recall of content cannot ensure its effective application, yet training in problem-solving skills with inadequate attention to factual content will not be effective either. Two educational programmes are described which aim to increase the effective linking of clinical strategy and clinical memory in undergraduate medical students. Clinical problem-solving sessions use simulated cases to provide experience in blending clinical knowledge and problem-solving strategies. Problemsolving examinations offer the opportunity for students to display the reasoning and planning behind their actions. They assess students' ability to use a problem-solving model and to document the medical work-up using the Problem Oriented Medical Record. Both educational programmes use concepts and theory developed in empirical research on medical problem solving. Fundamental research is used to raise questions about educational practice, while the practical concerns of education raise questions for substantive inquiry.

How we measure problem-solving ability

“…As Elstein, Sprafka & Bordage (1979) state, ‘It is worth remembering that medical problems are rarely solved by a process of reorganizing information presented to the problem solver at the start of the problem. Instead a sequence of data collection is almost always needed to illuminate the problem and provide the basis for its resolution’.…”