Lee Brooks - Academia.edu (original) (raw)

Papers by Lee Brooks

Research paper thumbnail of The Non-Analytical Basis of Clinical Reasoning

Advances in Health Sciences Education, 1997

This paper explores the assertion that much of clinical diagnostic thinking is based on the rapid... more This paper explores the assertion that much of clinical diagnostic thinking is based on the rapid and unconscious matching of the presenting problem to a similar, previously encountered, problem. This ‘non-analytic’ form of concept formation has been described in the psychology literature for over a decade. From this theory, we deduce and test several hypotheses: 1) Diagnosis is based in part on similarity to a particular previous example. In studies in dermatology, specific similarity accounts for about 30% of diagnosis. 2) When experts err, these errors are as likely as novices to occur on typical presentations. For residents, general practitioners and dermatologists, about 40% of errors were on typical slides. 3) Features are re-interpreted in light of diagnostic hypotheses. In radiology, attaching a standard positive history to the film bag increased the number of features seen on both normal and abnormal films by about 50%. 4) Experts cannot predict errors of other experts. In dermatology, experts predicted only 11–60% of errors committed by their colleagues. We conclude that amassing prior instances is an important component of expertise, and education should recognize this element.

Bookmarks Related papers MentionsView impact

Research paper thumbnail of The value of basic science in clinical diagnosis: creating coherence among signs and symptoms

Medical Education, 2005

Bookmarks Related papers MentionsView impact

Research paper thumbnail of Role of specific similarity in a medical diagnostic task

Journal of Experimental Psychology-general, 1991

Bookmarks Related papers MentionsView impact

Research paper thumbnail of Cognitive differences in clinical reasoning related to postgraduate training

Teaching and Learning in Medicine, 1994

In this study, first‐year residents in family medicine (FM), first‐ and second‐year residents in ... more In this study, first‐year residents in family medicine (FM), first‐ and second‐year residents in internal medicine, and experienced academic nephrologists were confronted with a series of eight complex nephrology problems, represented by a brief written history and a standard array of laboratory data. Subjects were asked to solve the problem while “thinking aloud.”; Results showed a large gradient in diagnostic ability over the three cohorts, ranging from a mean accuracy of 25% for FM residents to 91% for nephrologists. Increased experience was associated with increased clustering of individual data into meaningful relations and more extensive use of causal explanations but no difference in use of forward or backward reasoning. These results are at variance with an extensive literature showing (a) no or little difference in outcome measures of clinical competence related to postgraduate education but (b) greater use of forward reasoning and less use of causal biomedical explanations, associated with increased expertise. An explanation in terms of Schmidt and Norman's stage theory is proposed.

Bookmarks Related papers MentionsView impact

Research paper thumbnail of Specializing the operation of an explicit rule

Journal of Experimental Psychology-general, 1991

The effect of practice on the operative form of a rule was investigated by giving subjects an eas... more The effect of practice on the operative form of a rule was investigated by giving subjects an easy, perfectly predictive classification rule, followed by training in applying that rule to a set of practice items. On a subsequent transfer test, the accuracy and speed of classifying ...

Bookmarks Related papers MentionsView impact

Research paper thumbnail of Coordination of Analytic and Similarity-Based Processing Strategies and Expertise in Dermatological Diagnosis

Teaching and Learning in Medicine, 2001

Medical diagnosis may be thought of as a categorization task. Research and theory in psychology a... more Medical diagnosis may be thought of as a categorization task. Research and theory in psychology as well as medical decision making indicate at least 2 processes by which this categorization task may be accomplished: (a) analytic processing, in which one makes explicit use of clinical features to reach a diagnosis, and (b) similarity-based processing, in which one makes use of past exemplars to reach a clinical diagnosis. Recent research indicates that these 2 processes are complementary. We investigate the coordination of analytic and similarity-based processes in clinical decision making to examine if the relative reliance on these 2 processes is (a) amenable to instruction and (b) dependent on level of clinical experience. The reliance of these 2 processes was indexed by the performance of 12 preclinical medical students on cases dichotomized as typical and atypical (analytic processing) and on cases dichotomized as similar or dissimilar to cases seen previously in a training phase (similarity-based processing). The results indicated that both processes are operative. Of particular interest was that preclinical medical students enhanced their performance by adopting a similarity-based strategy. This was especially so for atypical cases. These results are in contrast to residents, who enhanced their performance by adopting an analytic strategy. The relative reliance on analytic and similarity-based processes is amenable to instruction and dependent on expertise.

Bookmarks Related papers MentionsView impact

Research paper thumbnail of Non-analytical models of clinical reasoning: the role of experience

Medical Education, 2007

Objective This paper aims to summarise the evidence supporting the role of experience-based, non... more Objective This paper aims to summarise the evidence supporting the role of experience-based, non-analytic reasoning (NAR) or pattern recognition as a central feature of expert medical diagnosis.Methods The authors examine a series of studies, primarily from their own research programme at McMaster University, that demonstrate that expert and novice diagnostic problem solving is based, to some degree, on similarity to a prior specific exemplar in the memory.Results The studies reviewed have shown NAR to be a component of diagnostic reasoning at all levels from novice to subspecialist, and in dermatology, electrocardiography and psychiatry. The retrieval process is rapid and is not available to retrospection. It may be based on visual similarity, but can also be present in verbal descriptions. Some evidence exists that the process is unlikely to be available to introspection. Further, early hypotheses based on NAR can result in the reinterpretaton of critical clinical findings.Conclusions Non-analytic reasoning is a central component of diagnostic expertise at all levels. Clinical teaching should recognise the centrality of this process, and aim to both enhance the process through the learning of multiple examples and to supplement the process with analytical de-biasing strategies.

Bookmarks Related papers MentionsView impact

Research paper thumbnail of The correlation of feature identification and category judgments in diagnostic radiology

Memory & Cognition, 1992

Expert and novice radiologists were given films accompanied-by-clinical histories that supported ... more Expert and novice radiologists were given films accompanied-by-clinical histories that supported a diagnosis either of bronchiolitis or of normal. To provide a plausible task context, some films were radiologically unambiguous and were accompanied by histories consistent with them. For a set of radiologically difficult films from confirmed normal or bronchiolitis patients, fictitious normal or abnormal histories were counterbalanced with the films. The clinical histories affected ratings both of diagnosis and of features present on the difficult films. Thus, uncertainty about individual features evidently was affected by history, and features did not act as an independent source of information. The dependence of feature calls on an overall judgment was also suggested by intra-observer agreement in another study in which an explicit diagnosis was not requested. It is unclear whether the history increased discrimination between normal and -abnormal films, or indiscriminately added evidence for or against the disease. Factors are discussed that make it appropriate for feature identification to be partially dependent on category identification.

Bookmarks Related papers MentionsView impact

Research paper thumbnail of Practice Makes Perfect: The Critical Role of Mixed Practice in the Acquisition of ECG Interpretation Skills

Advances in Health Sciences Education, 2003

Purpose. To examine the effect of instructional format on medical students' learning of ECG diagn... more Purpose. To examine the effect of instructional format on medical students' learning of ECG diagnosis. Method. Two experiments employed different learning and practice methods. In the first, students were randomly allocated to one of two instructional approaches, one organized around features (e.g., QRS voltage) and the other around diagnostic categories (e.g., bundle branch blocks), followed by a practice phase. In the second experiment, the instruction was standardized, and students were randomly allocated to one of two practice phases, either “contrastive” where examples from various categories are mixed together, or “non-contrastive” where all the examples in a single category are practiced in a single block.Results. In the first experiment, there was no significant differences in students' diagnostic accuracy on novel ECG examples. In the second experiment, students exposed to the contrastive approach in the practice phase had superior diagnostic accuracy (46%) compared to 30% accuracy for the non-contrastive session, p < 0.05).Conclusion. These experiments highlight two important features in the design of instructional materials. First, learning around the features of the problem (analogous to problem – based learning) may have no advantages over learning the category. Second, the design and organization of deliberate practice can result in significant learning gain.

Bookmarks Related papers MentionsView impact

Research paper thumbnail of The Non-Analytical Basis of Clinical Reasoning

Advances in Health Sciences Education, 1997

This paper explores the assertion that much of clinical diagnostic thinking is based on the rapid... more This paper explores the assertion that much of clinical diagnostic thinking is based on the rapid and unconscious matching of the presenting problem to a similar, previously encountered, problem. This ‘non-analytic’ form of concept formation has been described in the psychology literature for over a decade. From this theory, we deduce and test several hypotheses: 1) Diagnosis is based in part on similarity to a particular previous example. In studies in dermatology, specific similarity accounts for about 30% of diagnosis. 2) When experts err, these errors are as likely as novices to occur on typical presentations. For residents, general practitioners and dermatologists, about 40% of errors were on typical slides. 3) Features are re-interpreted in light of diagnostic hypotheses. In radiology, attaching a standard positive history to the film bag increased the number of features seen on both normal and abnormal films by about 50%. 4) Experts cannot predict errors of other experts. In dermatology, experts predicted only 11–60% of errors committed by their colleagues. We conclude that amassing prior instances is an important component of expertise, and education should recognize this element.

Bookmarks Related papers MentionsView impact

Research paper thumbnail of Impact of a clinical scenario on accuracy of electrocardiogram interpretation

Journal of General Internal Medicine, 1999

To examine the effect of clinical history on the electrocardiogram (ECG) interpretation skills of... more To examine the effect of clinical history on the electrocardiogram (ECG) interpretation skills of physicians with different levels of expertise, we randomly allocated to an ECG test package 30 final-year medical students, 15 second-year internal medicine residents, and 15 university cardiologists at university-affiliated teaching hospitals. All participants interpreted the same set of 10 ECGs. Each ECG was accompanied by a brief clinical history suggestive of the correct ECG diagnosis, or the most plausible alternative diagnosis, or no history. Provision of a correct history improved accuracy by 4% to 12% compared with no history, depending on level of training. Conversely, a misleading history compared with no history reduced accuracy by 5% for cardiologists, 25% for residents, and 19% for students. Clinical history also affected the paticipants’ frequencies of listing ECG features consistent with the correct diagnosis and features consistent with the alternative diagnosis (allp values <.05). For physicians at all levels of expertise, clinical history has an influence on ECG diagnostic accuracy, both improving accuracy when the history suggests the correct diagnosis, and reducing accuracy when the history suggests an alternative diagnosis.

Bookmarks Related papers MentionsView impact

Research paper thumbnail of The value of basic science in clinical diagnosis: creating coherence among signs and symptoms

Medical Education, 2005

Bookmarks Related papers MentionsView impact

Research paper thumbnail of Recall by expert medical practitioners and novices as a record of processing attention

Journal of Experimental Psychology-learning Memory and Cognition, 1989

Using recall of clinical protocols as a measure of expertise in medicine has yielded disappointin... more Using recall of clinical protocols as a measure of expertise in medicine has yielded disappointingly small effects. Experiments using recall of clinical laboratory data are presented to provide an explanation. In one experiment, subjects either deliberately memorized or first diagnosed and then were incidentally asked for memory. With incidental instructions, experts recalled over twice as much data as did students, but with memorization instructions, student performance approximated that of experts. Experts also showed a large advantage over students in incidental recall of data that were not relevant to the problem solution. These results suggest that expert processing in this &amp;amp;amp;amp;quot;discrete, independent inputs&amp;amp;amp;amp;quot; domain requires effortful analysis with minimal reliance on default values, rather than relatively effortless pattern perception reported in highly visual areas of expertise. For this area, intentional memory is a misleading measure of expertise. However, incidental memory is a valuable measure of processing during diagnosis.

Bookmarks Related papers MentionsView impact

Research paper thumbnail of Role of specific similarity in a medical diagnostic task

Journal of Experimental Psychology-general, 1991

Bookmarks Related papers MentionsView impact

Research paper thumbnail of Influence of a Single Example on Subsequent Electrocardiogram Interpretation

Teaching and Learning in Medicine, 1999

ABSTRACT

Bookmarks Related papers MentionsView impact

Research paper thumbnail of Cognitive differences in clinical reasoning related to postgraduate training

Teaching and Learning in Medicine, 1994

In this study, first‐year residents in family medicine (FM), first‐ and second‐year residents in ... more In this study, first‐year residents in family medicine (FM), first‐ and second‐year residents in internal medicine, and experienced academic nephrologists were confronted with a series of eight complex nephrology problems, represented by a brief written history and a standard array of laboratory data. Subjects were asked to solve the problem while “thinking aloud.”; Results showed a large gradient in diagnostic ability over the three cohorts, ranging from a mean accuracy of 25% for FM residents to 91% for nephrologists. Increased experience was associated with increased clustering of individual data into meaningful relations and more extensive use of causal explanations but no difference in use of forward or backward reasoning. These results are at variance with an extensive literature showing (a) no or little difference in outcome measures of clinical competence related to postgraduate education but (b) greater use of forward reasoning and less use of causal biomedical explanations, associated with increased expertise. An explanation in terms of Schmidt and Norman's stage theory is proposed.

Bookmarks Related papers MentionsView impact

Research paper thumbnail of The Benefit of Diagnostic Hypotheses in Clinical Reasoning: Experimental Study of an Instructional Intervention for Forward and Backward Reasoning

Cognition and Instruction, 1999

Bookmarks Related papers MentionsView impact

Research paper thumbnail of Specializing the operation of an explicit rule

Journal of Experimental Psychology-general, 1991

The effect of practice on the operative form of a rule was investigated by giving subjects an eas... more The effect of practice on the operative form of a rule was investigated by giving subjects an easy, perfectly predictive classification rule, followed by training in applying that rule to a set of practice items. On a subsequent transfer test, the accuracy and speed of classifying ...

Bookmarks Related papers MentionsView impact

Research paper thumbnail of Coordination of Analytic and Similarity-Based Processing Strategies and Expertise in Dermatological Diagnosis

Teaching and Learning in Medicine, 2001

Medical diagnosis may be thought of as a categorization task. Research and theory in psychology a... more Medical diagnosis may be thought of as a categorization task. Research and theory in psychology as well as medical decision making indicate at least 2 processes by which this categorization task may be accomplished: (a) analytic processing, in which one makes explicit use of clinical features to reach a diagnosis, and (b) similarity-based processing, in which one makes use of past exemplars to reach a clinical diagnosis. Recent research indicates that these 2 processes are complementary. We investigate the coordination of analytic and similarity-based processes in clinical decision making to examine if the relative reliance on these 2 processes is (a) amenable to instruction and (b) dependent on level of clinical experience. The reliance of these 2 processes was indexed by the performance of 12 preclinical medical students on cases dichotomized as typical and atypical (analytic processing) and on cases dichotomized as similar or dissimilar to cases seen previously in a training phase (similarity-based processing). The results indicated that both processes are operative. Of particular interest was that preclinical medical students enhanced their performance by adopting a similarity-based strategy. This was especially so for atypical cases. These results are in contrast to residents, who enhanced their performance by adopting an analytic strategy. The relative reliance on analytic and similarity-based processes is amenable to instruction and dependent on expertise.

Bookmarks Related papers MentionsView impact

Research paper thumbnail of Non-analytical models of clinical reasoning: the role of experience

Medical Education, 2007

Objective This paper aims to summarise the evidence supporting the role of experience-based, non... more Objective This paper aims to summarise the evidence supporting the role of experience-based, non-analytic reasoning (NAR) or pattern recognition as a central feature of expert medical diagnosis.Methods The authors examine a series of studies, primarily from their own research programme at McMaster University, that demonstrate that expert and novice diagnostic problem solving is based, to some degree, on similarity to a prior specific exemplar in the memory.Results The studies reviewed have shown NAR to be a component of diagnostic reasoning at all levels from novice to subspecialist, and in dermatology, electrocardiography and psychiatry. The retrieval process is rapid and is not available to retrospection. It may be based on visual similarity, but can also be present in verbal descriptions. Some evidence exists that the process is unlikely to be available to introspection. Further, early hypotheses based on NAR can result in the reinterpretaton of critical clinical findings.Conclusions Non-analytic reasoning is a central component of diagnostic expertise at all levels. Clinical teaching should recognise the centrality of this process, and aim to both enhance the process through the learning of multiple examples and to supplement the process with analytical de-biasing strategies.

Bookmarks Related papers MentionsView impact

Research paper thumbnail of The Non-Analytical Basis of Clinical Reasoning

Advances in Health Sciences Education, 1997

This paper explores the assertion that much of clinical diagnostic thinking is based on the rapid... more This paper explores the assertion that much of clinical diagnostic thinking is based on the rapid and unconscious matching of the presenting problem to a similar, previously encountered, problem. This ‘non-analytic’ form of concept formation has been described in the psychology literature for over a decade. From this theory, we deduce and test several hypotheses: 1) Diagnosis is based in part on similarity to a particular previous example. In studies in dermatology, specific similarity accounts for about 30% of diagnosis. 2) When experts err, these errors are as likely as novices to occur on typical presentations. For residents, general practitioners and dermatologists, about 40% of errors were on typical slides. 3) Features are re-interpreted in light of diagnostic hypotheses. In radiology, attaching a standard positive history to the film bag increased the number of features seen on both normal and abnormal films by about 50%. 4) Experts cannot predict errors of other experts. In dermatology, experts predicted only 11–60% of errors committed by their colleagues. We conclude that amassing prior instances is an important component of expertise, and education should recognize this element.

Bookmarks Related papers MentionsView impact

Research paper thumbnail of The value of basic science in clinical diagnosis: creating coherence among signs and symptoms

Medical Education, 2005

Bookmarks Related papers MentionsView impact

Research paper thumbnail of Role of specific similarity in a medical diagnostic task

Journal of Experimental Psychology-general, 1991

Bookmarks Related papers MentionsView impact

Research paper thumbnail of Cognitive differences in clinical reasoning related to postgraduate training

Teaching and Learning in Medicine, 1994

In this study, first‐year residents in family medicine (FM), first‐ and second‐year residents in ... more In this study, first‐year residents in family medicine (FM), first‐ and second‐year residents in internal medicine, and experienced academic nephrologists were confronted with a series of eight complex nephrology problems, represented by a brief written history and a standard array of laboratory data. Subjects were asked to solve the problem while “thinking aloud.”; Results showed a large gradient in diagnostic ability over the three cohorts, ranging from a mean accuracy of 25% for FM residents to 91% for nephrologists. Increased experience was associated with increased clustering of individual data into meaningful relations and more extensive use of causal explanations but no difference in use of forward or backward reasoning. These results are at variance with an extensive literature showing (a) no or little difference in outcome measures of clinical competence related to postgraduate education but (b) greater use of forward reasoning and less use of causal biomedical explanations, associated with increased expertise. An explanation in terms of Schmidt and Norman's stage theory is proposed.

Bookmarks Related papers MentionsView impact

Research paper thumbnail of Specializing the operation of an explicit rule

Journal of Experimental Psychology-general, 1991

The effect of practice on the operative form of a rule was investigated by giving subjects an eas... more The effect of practice on the operative form of a rule was investigated by giving subjects an easy, perfectly predictive classification rule, followed by training in applying that rule to a set of practice items. On a subsequent transfer test, the accuracy and speed of classifying ...

Bookmarks Related papers MentionsView impact

Research paper thumbnail of Coordination of Analytic and Similarity-Based Processing Strategies and Expertise in Dermatological Diagnosis

Teaching and Learning in Medicine, 2001

Medical diagnosis may be thought of as a categorization task. Research and theory in psychology a... more Medical diagnosis may be thought of as a categorization task. Research and theory in psychology as well as medical decision making indicate at least 2 processes by which this categorization task may be accomplished: (a) analytic processing, in which one makes explicit use of clinical features to reach a diagnosis, and (b) similarity-based processing, in which one makes use of past exemplars to reach a clinical diagnosis. Recent research indicates that these 2 processes are complementary. We investigate the coordination of analytic and similarity-based processes in clinical decision making to examine if the relative reliance on these 2 processes is (a) amenable to instruction and (b) dependent on level of clinical experience. The reliance of these 2 processes was indexed by the performance of 12 preclinical medical students on cases dichotomized as typical and atypical (analytic processing) and on cases dichotomized as similar or dissimilar to cases seen previously in a training phase (similarity-based processing). The results indicated that both processes are operative. Of particular interest was that preclinical medical students enhanced their performance by adopting a similarity-based strategy. This was especially so for atypical cases. These results are in contrast to residents, who enhanced their performance by adopting an analytic strategy. The relative reliance on analytic and similarity-based processes is amenable to instruction and dependent on expertise.

Bookmarks Related papers MentionsView impact

Research paper thumbnail of Non-analytical models of clinical reasoning: the role of experience

Medical Education, 2007

Objective This paper aims to summarise the evidence supporting the role of experience-based, non... more Objective This paper aims to summarise the evidence supporting the role of experience-based, non-analytic reasoning (NAR) or pattern recognition as a central feature of expert medical diagnosis.Methods The authors examine a series of studies, primarily from their own research programme at McMaster University, that demonstrate that expert and novice diagnostic problem solving is based, to some degree, on similarity to a prior specific exemplar in the memory.Results The studies reviewed have shown NAR to be a component of diagnostic reasoning at all levels from novice to subspecialist, and in dermatology, electrocardiography and psychiatry. The retrieval process is rapid and is not available to retrospection. It may be based on visual similarity, but can also be present in verbal descriptions. Some evidence exists that the process is unlikely to be available to introspection. Further, early hypotheses based on NAR can result in the reinterpretaton of critical clinical findings.Conclusions Non-analytic reasoning is a central component of diagnostic expertise at all levels. Clinical teaching should recognise the centrality of this process, and aim to both enhance the process through the learning of multiple examples and to supplement the process with analytical de-biasing strategies.

Bookmarks Related papers MentionsView impact

Research paper thumbnail of The correlation of feature identification and category judgments in diagnostic radiology

Memory & Cognition, 1992

Expert and novice radiologists were given films accompanied-by-clinical histories that supported ... more Expert and novice radiologists were given films accompanied-by-clinical histories that supported a diagnosis either of bronchiolitis or of normal. To provide a plausible task context, some films were radiologically unambiguous and were accompanied by histories consistent with them. For a set of radiologically difficult films from confirmed normal or bronchiolitis patients, fictitious normal or abnormal histories were counterbalanced with the films. The clinical histories affected ratings both of diagnosis and of features present on the difficult films. Thus, uncertainty about individual features evidently was affected by history, and features did not act as an independent source of information. The dependence of feature calls on an overall judgment was also suggested by intra-observer agreement in another study in which an explicit diagnosis was not requested. It is unclear whether the history increased discrimination between normal and -abnormal films, or indiscriminately added evidence for or against the disease. Factors are discussed that make it appropriate for feature identification to be partially dependent on category identification.

Bookmarks Related papers MentionsView impact

Research paper thumbnail of Practice Makes Perfect: The Critical Role of Mixed Practice in the Acquisition of ECG Interpretation Skills

Advances in Health Sciences Education, 2003

Purpose. To examine the effect of instructional format on medical students' learning of ECG diagn... more Purpose. To examine the effect of instructional format on medical students' learning of ECG diagnosis. Method. Two experiments employed different learning and practice methods. In the first, students were randomly allocated to one of two instructional approaches, one organized around features (e.g., QRS voltage) and the other around diagnostic categories (e.g., bundle branch blocks), followed by a practice phase. In the second experiment, the instruction was standardized, and students were randomly allocated to one of two practice phases, either “contrastive” where examples from various categories are mixed together, or “non-contrastive” where all the examples in a single category are practiced in a single block.Results. In the first experiment, there was no significant differences in students' diagnostic accuracy on novel ECG examples. In the second experiment, students exposed to the contrastive approach in the practice phase had superior diagnostic accuracy (46%) compared to 30% accuracy for the non-contrastive session, p < 0.05).Conclusion. These experiments highlight two important features in the design of instructional materials. First, learning around the features of the problem (analogous to problem – based learning) may have no advantages over learning the category. Second, the design and organization of deliberate practice can result in significant learning gain.

Bookmarks Related papers MentionsView impact

Research paper thumbnail of The Non-Analytical Basis of Clinical Reasoning

Advances in Health Sciences Education, 1997

This paper explores the assertion that much of clinical diagnostic thinking is based on the rapid... more This paper explores the assertion that much of clinical diagnostic thinking is based on the rapid and unconscious matching of the presenting problem to a similar, previously encountered, problem. This ‘non-analytic’ form of concept formation has been described in the psychology literature for over a decade. From this theory, we deduce and test several hypotheses: 1) Diagnosis is based in part on similarity to a particular previous example. In studies in dermatology, specific similarity accounts for about 30% of diagnosis. 2) When experts err, these errors are as likely as novices to occur on typical presentations. For residents, general practitioners and dermatologists, about 40% of errors were on typical slides. 3) Features are re-interpreted in light of diagnostic hypotheses. In radiology, attaching a standard positive history to the film bag increased the number of features seen on both normal and abnormal films by about 50%. 4) Experts cannot predict errors of other experts. In dermatology, experts predicted only 11–60% of errors committed by their colleagues. We conclude that amassing prior instances is an important component of expertise, and education should recognize this element.

Bookmarks Related papers MentionsView impact

Research paper thumbnail of Impact of a clinical scenario on accuracy of electrocardiogram interpretation

Journal of General Internal Medicine, 1999

To examine the effect of clinical history on the electrocardiogram (ECG) interpretation skills of... more To examine the effect of clinical history on the electrocardiogram (ECG) interpretation skills of physicians with different levels of expertise, we randomly allocated to an ECG test package 30 final-year medical students, 15 second-year internal medicine residents, and 15 university cardiologists at university-affiliated teaching hospitals. All participants interpreted the same set of 10 ECGs. Each ECG was accompanied by a brief clinical history suggestive of the correct ECG diagnosis, or the most plausible alternative diagnosis, or no history. Provision of a correct history improved accuracy by 4% to 12% compared with no history, depending on level of training. Conversely, a misleading history compared with no history reduced accuracy by 5% for cardiologists, 25% for residents, and 19% for students. Clinical history also affected the paticipants’ frequencies of listing ECG features consistent with the correct diagnosis and features consistent with the alternative diagnosis (allp values <.05). For physicians at all levels of expertise, clinical history has an influence on ECG diagnostic accuracy, both improving accuracy when the history suggests the correct diagnosis, and reducing accuracy when the history suggests an alternative diagnosis.

Bookmarks Related papers MentionsView impact

Research paper thumbnail of The value of basic science in clinical diagnosis: creating coherence among signs and symptoms

Medical Education, 2005

Bookmarks Related papers MentionsView impact

Research paper thumbnail of Recall by expert medical practitioners and novices as a record of processing attention

Journal of Experimental Psychology-learning Memory and Cognition, 1989

Using recall of clinical protocols as a measure of expertise in medicine has yielded disappointin... more Using recall of clinical protocols as a measure of expertise in medicine has yielded disappointingly small effects. Experiments using recall of clinical laboratory data are presented to provide an explanation. In one experiment, subjects either deliberately memorized or first diagnosed and then were incidentally asked for memory. With incidental instructions, experts recalled over twice as much data as did students, but with memorization instructions, student performance approximated that of experts. Experts also showed a large advantage over students in incidental recall of data that were not relevant to the problem solution. These results suggest that expert processing in this &amp;amp;amp;amp;quot;discrete, independent inputs&amp;amp;amp;amp;quot; domain requires effortful analysis with minimal reliance on default values, rather than relatively effortless pattern perception reported in highly visual areas of expertise. For this area, intentional memory is a misleading measure of expertise. However, incidental memory is a valuable measure of processing during diagnosis.

Bookmarks Related papers MentionsView impact

Research paper thumbnail of Role of specific similarity in a medical diagnostic task

Journal of Experimental Psychology-general, 1991

Bookmarks Related papers MentionsView impact

Research paper thumbnail of Influence of a Single Example on Subsequent Electrocardiogram Interpretation

Teaching and Learning in Medicine, 1999

ABSTRACT

Bookmarks Related papers MentionsView impact

Research paper thumbnail of Cognitive differences in clinical reasoning related to postgraduate training

Teaching and Learning in Medicine, 1994

In this study, first‐year residents in family medicine (FM), first‐ and second‐year residents in ... more In this study, first‐year residents in family medicine (FM), first‐ and second‐year residents in internal medicine, and experienced academic nephrologists were confronted with a series of eight complex nephrology problems, represented by a brief written history and a standard array of laboratory data. Subjects were asked to solve the problem while “thinking aloud.”; Results showed a large gradient in diagnostic ability over the three cohorts, ranging from a mean accuracy of 25% for FM residents to 91% for nephrologists. Increased experience was associated with increased clustering of individual data into meaningful relations and more extensive use of causal explanations but no difference in use of forward or backward reasoning. These results are at variance with an extensive literature showing (a) no or little difference in outcome measures of clinical competence related to postgraduate education but (b) greater use of forward reasoning and less use of causal biomedical explanations, associated with increased expertise. An explanation in terms of Schmidt and Norman's stage theory is proposed.

Bookmarks Related papers MentionsView impact

Research paper thumbnail of The Benefit of Diagnostic Hypotheses in Clinical Reasoning: Experimental Study of an Instructional Intervention for Forward and Backward Reasoning

Cognition and Instruction, 1999

Bookmarks Related papers MentionsView impact

Research paper thumbnail of Specializing the operation of an explicit rule

Journal of Experimental Psychology-general, 1991

The effect of practice on the operative form of a rule was investigated by giving subjects an eas... more The effect of practice on the operative form of a rule was investigated by giving subjects an easy, perfectly predictive classification rule, followed by training in applying that rule to a set of practice items. On a subsequent transfer test, the accuracy and speed of classifying ...

Bookmarks Related papers MentionsView impact

Research paper thumbnail of Coordination of Analytic and Similarity-Based Processing Strategies and Expertise in Dermatological Diagnosis

Teaching and Learning in Medicine, 2001

Medical diagnosis may be thought of as a categorization task. Research and theory in psychology a... more Medical diagnosis may be thought of as a categorization task. Research and theory in psychology as well as medical decision making indicate at least 2 processes by which this categorization task may be accomplished: (a) analytic processing, in which one makes explicit use of clinical features to reach a diagnosis, and (b) similarity-based processing, in which one makes use of past exemplars to reach a clinical diagnosis. Recent research indicates that these 2 processes are complementary. We investigate the coordination of analytic and similarity-based processes in clinical decision making to examine if the relative reliance on these 2 processes is (a) amenable to instruction and (b) dependent on level of clinical experience. The reliance of these 2 processes was indexed by the performance of 12 preclinical medical students on cases dichotomized as typical and atypical (analytic processing) and on cases dichotomized as similar or dissimilar to cases seen previously in a training phase (similarity-based processing). The results indicated that both processes are operative. Of particular interest was that preclinical medical students enhanced their performance by adopting a similarity-based strategy. This was especially so for atypical cases. These results are in contrast to residents, who enhanced their performance by adopting an analytic strategy. The relative reliance on analytic and similarity-based processes is amenable to instruction and dependent on expertise.

Bookmarks Related papers MentionsView impact

Research paper thumbnail of Non-analytical models of clinical reasoning: the role of experience

Medical Education, 2007

Objective This paper aims to summarise the evidence supporting the role of experience-based, non... more Objective This paper aims to summarise the evidence supporting the role of experience-based, non-analytic reasoning (NAR) or pattern recognition as a central feature of expert medical diagnosis.Methods The authors examine a series of studies, primarily from their own research programme at McMaster University, that demonstrate that expert and novice diagnostic problem solving is based, to some degree, on similarity to a prior specific exemplar in the memory.Results The studies reviewed have shown NAR to be a component of diagnostic reasoning at all levels from novice to subspecialist, and in dermatology, electrocardiography and psychiatry. The retrieval process is rapid and is not available to retrospection. It may be based on visual similarity, but can also be present in verbal descriptions. Some evidence exists that the process is unlikely to be available to introspection. Further, early hypotheses based on NAR can result in the reinterpretaton of critical clinical findings.Conclusions Non-analytic reasoning is a central component of diagnostic expertise at all levels. Clinical teaching should recognise the centrality of this process, and aim to both enhance the process through the learning of multiple examples and to supplement the process with analytical de-biasing strategies.

Bookmarks Related papers MentionsView impact