The role of strategy and redundancy in diagnostic reasoning

dc.creator	Feller Sabine
dc.creator	Hofer Daniel
dc.creator	Bloch Ralph F
dc.creator	Hodel Maria
dc.date	2003-01-01T00:00:00Z
dc.date.accessioned	2015-07-20T22:29:15Z
dc.date.available	2015-07-20T22:29:15Z
dc.identifier	10.1186/1472-6920-3-1
dc.identifier	1472-6920
dc.identifier	https://doaj.org/article/aef93b06001a429fbff254a7f0b344e7
dc.identifier.uri	http://evidence.thinkportal.org/handle/123456789/22117
dc.description	<p>Abstract</p> <p>Background</p> <p>Diagnostic reasoning is a key competence of physicians. We explored the effects of knowledge, practice and additional clinical information on strategy, redundancy and accuracy of diagnosing a peripheral neurological defect in the hand based on sensory examination.</p> <p>Method</p> <p>Using an interactive computer simulation that includes 21 unique cases with seven sensory loss patterns and either concordant, neutral or discordant textual information, 21 3rd year medical students, 21 6th year and 21 senior neurology residents each examined 15 cases over the course of one session. An additional 23 psychology students examined 24 cases over two sessions, 12 cases per session. Subjects also took a seven-item MCQ exam of seven classical patterns presented visually.</p> <p>Results</p> <p>Knowledge of sensory patterns and diagnostic accuracy are highly correlated within groups (<it>R</it><sup>2 </sup>= 0.64). The total amount of information gathered for incorrect diagnoses is no lower than that for correct diagnoses. Residents require significantly fewer tests than either psychology or 6th year students, who in turn require fewer than the 3rd year students (p < 0.001). The diagnostic accuracy of subjects is affected both by level of training (p < 0.001) and concordance of clinical information (p < 0.001). For discordant cases, refutation testing occurs significantly in 6th year students (p < 0.001) and residents (p < 0.01), but not in psychology or 3rd year students. Conversely, there is a stable 55% excess of confirmatory testing, independent of training or concordance.</p> <p>Conclusions</p> <p>Knowledge and practice are both important for diagnostic success. For complex diagnostic situations reasoning components employing redundancy seem more essential than those using strategy.</p>
dc.language	English
dc.publisher	BioMed Central
dc.relation	http://www.biomedcentral.com/1472-6920/3/1
dc.relation	https://doaj.org/toc/1472-6920
dc.rights	CC BY
dc.source	BMC Medical Education, Vol 3, Iss 1, p 1 (2003)
dc.subject	diagnostic reasoning
dc.subject	clinical decision making
dc.subject	medical education
dc.subject	cognitive psychology
dc.subject	entropy
dc.subject	experimental studies
dc.subject	Medicine (General)
dc.subject	R5-920
dc.subject	Medicine
dc.subject	R
dc.subject	DOAJ:Medicine (General)
dc.subject	DOAJ:Health Sciences
dc.subject	Special aspects of education
dc.subject	LC8-6691
dc.subject	Education
dc.subject	L
dc.subject	DOAJ:Education
dc.subject	DOAJ:Social Sciences
dc.subject	Medicine (General)
dc.subject	R5-920
dc.subject	Medicine
dc.subject	R
dc.subject	DOAJ:Medicine (General)
dc.subject	DOAJ:Health Sciences
dc.subject	Special aspects of education
dc.subject	LC8-6691
dc.subject	Education
dc.subject	L
dc.subject	DOAJ:Education
dc.subject	DOAJ:Social Sciences
dc.subject	Medicine (General)
dc.subject	R5-920
dc.subject	Medicine
dc.subject	R
dc.subject	Special aspects of education
dc.subject	LC8-6691
dc.subject	Education
dc.subject	L
dc.subject	Medicine (General)
dc.subject	R5-920
dc.subject	Medicine
dc.subject	R
dc.subject	Special aspects of education
dc.subject	LC8-6691
dc.subject	Education
dc.subject	L
dc.subject	Medicine (General)
dc.subject	R5-920
dc.subject	Medicine
dc.subject	R
dc.subject	Special aspects of education
dc.subject	LC8-6691
dc.subject	Education
dc.subject	L
dc.title	The role of strategy and redundancy in diagnostic reasoning
dc.type	article