Diagnostic Reasoning across the Medical Education Continuum

Healthcare

C. Scott Smith¹  William Hill¹  Chris Francovich¹  Magdalena Morris¹  Bruce Robbins³  Lynne Robins² 

[1] Department of Medicine, VA Medical Center, Boise, ID 83702, USA; E-Mails:;Behavioral Informatics and Medical Education, University of Washington, Seattle, WA 98195, USA; E-Mail:;English Department, Boise State University, Boise, ID 83725, USA; E-Mail:

关键词: undergraduate medical education;    graduate medical education;    emotional stress;    narrative medicine;    diagnostic reasoning;    professional competence;    curriculum;    personal narratives;   

DOI  :  10.3390/healthcare2030253

来源: mdpi

【 摘 要 】

We aimed to study linguistic and non-linguistic elements of diagnostic reasoning across the continuum of medical education. We performed semi-structured interviews of premedical students, first year medical students, third year medical students, second year internal medicine residents, and experienced faculty (ten each) as they diagnosed three common causes of dyspnea. A second observer recorded emotional tone. All interviews were digitally recorded and blinded transcripts were created. Propositional analysis and concept mapping were performed. Grounded theory was used to identify salient categories and transcripts were scored with these categories. Transcripts were then unblinded. Systematic differences in propositional structure, number of concept connections, distribution of grounded theory categories, episodic and semantic memories, and emotional tone were identified. Summary concept maps were created and grounded theory concepts were explored for each learning level. We identified three major findings: (1) The “apprentice effect” in novices (high stress and low narrative competence); (2) logistic concept growth in intermediates; and (3) a cognitive state transition (between analytical and intuitive approaches) in experts. These findings warrant further study and comparison.

【 授权许可】

CC BY   
© 2014 by the authors; licensee MDPI, Basel, Switzerland.