Jose Alberto Quintana Arocha - Academia.edu (original) (raw)

Papers by Jose Alberto Quintana Arocha

CHAPTER FIVE Expertise and Tacit Knowledge in Medicine Vimla L. Patel José F. Arocha McGill Unive... more CHAPTER FIVE Expertise and Tacit Knowledge in Medicine Vimla L. Patel José F. Arocha McGill University David R. Kaufman University of California, Berkeley All nature is art, unknown to thee; All chance, direction, which thou canst not see; All discord, harmony not understood; ...

Journal of Dental Education, 2005

Petracos también pretende ser una herramienta para favorecer la transparencia y eficacia de la in... more Petracos también pretende ser una herramienta para favorecer la transparencia y eficacia de la investigación arqueológica desarrollada, transfiriendo a la sociedad el conocimiento generado con la mayor rigurosidad posible. Esta serie asegura la calidad de los estudios publicados mediante un riguroso proceso de revisión de los manuscritos remitidos y el aval de informes externos de especialistas relacionados con la materia, aunque no se identifica necesariamente con el contenido de los trabajos publicados.

Journal of Dental Education, 2001

This article reports a study comparing the problem-solving performance of housestaff with undergr... more This article reports a study comparing the problem-solving performance of housestaff with undergraduate medical training in either conventional or problem-based schools. After reading two clinical cases, residents were required to write differential diagnoses and pathophysiological explanations. Biomedical and clinical knowledge used and reasoning strategies were identified. The results suggest that housestaff performance is influenced by the nature of instruction. Housestaff trained in a conventional curriculum (CC) focused on patient information, separated biomedical from clinical knowledge, and used datadriven strategies. Housestaff from problem-based learning curricula (PBLC) organized their knowledge around generated inferences, integrated biomedical and clinical knowledge, and used hypothesis-driven strategies. Data-driven reasoning appears to be impeded in PBLC, suggesting that PBLC students have difficulties in acquiring problem schemata. Previous investigations also found this pattern to be true for medical students trained in two different curriculum formats. Although all housestaff generated equal numbers of diagnostic hypotheses during the reasoning process, housestaff from the conventional curriculum generated a greater number of accurate hypotheses than residents in PBLC. These results are discussed in relation to assumptions in health professional curricula about the adequacy of hypothetico-deductive methods of reasoning as teaching mechanisms and the need for clinical and biomedical knowledge integration.

Journal of Dental Education, 2004

Components of problem-based education, such as small group teaching, are being implemented in div... more Components of problem-based education, such as small group teaching, are being implemented in diverse health curricula. Implementation, however, is often motivated by the intuitive appeal of many problem-based learning components, when what is needed is the detailed examination of how these components support students' integration of knowledge as well as continuity of their learning experiences. This study presents an investigation of the relationship between lecture and small group teaching (SGT) in a medical curriculum. Four problem-oriented SGT sessions representing diverse topics in the first-year curriculum and their corresponding lectures were videotaped and analyzed using techniques of concept mapping, where the broad concepts from the lectures were identified and matched to the case-specific concepts in the small group sessions. The results show that lectures function as an anchor for the students' discussion of issues relevant to clinical problem-solving and interventions in small group sessions. These discussions extended to contextual aspects of clinical practice that were not dealt with in the lectures, such as ethical/cultural issues around the treatment of patients. Furthermore, small group environments were found to promote discussions that allowed the integration of information from different sources and encompassed concepts across a number of disciplines. These results suggest that carefully designed small group sessions serve the purposes of 1) illustrating broader concepts in lectures to case-specific, clinically relevant problem-solving and 2) promoting knowledge integration from diverse sources of information. The implications of these results for learning and reasoning in health science curricula are discussed.

Rev Soc Med Quir Hosp Emerg Perez De Leon, Oct 1, 1987

Medical Decision Making, 1993

This study investigates hypothesis generation and evaluation in clinical problem solving by medic... more This study investigates hypothesis generation and evaluation in clinical problem solving by medical trainees. The study focuses on 1) directionality of reasoning and 2) use of confir mation and disconfirmation strategies in generating and evaluating hypotheses. Two clinical problems were divided into segments of information containing presenting complaint, past history, and physical examination. The initial information indicated a typical myocardial infarct but subsequent information contradicted it. The results showed that the participating students predominantly used forward reasoning and confirmation strategies. When faced with con tradictory evidence: 1) second-year students ignored cues in the problem or reinterpreted them to fit the hypothesis; 2) third-year students generated concurrent hypotheses to account for different sets of data; and 3) fourth-year students generated several initial hypotheses and subsequently narrowed the hypothesis space by generating a single coheren...

Informatics for health & social care, 2015

Consumer health informatics (CHI) is an emerging field that utilizes technology to provide health... more Consumer health informatics (CHI) is an emerging field that utilizes technology to provide health information to enhance health-care decision making by the public. There is, however, no widely accepted or uniform definition of CHI. A consensus definition would be important for pedagogical reasons, to build capacity and to reduce confusion about what the discipline consists of. We undertook a systematic review of published definitions of CHI and evaluated them using five quality assessment criteria and measures of similarity. Five databases were searched (Embase, Web of Science, MEDLINE, CINAHL and Business Source Complete) resulting in 1101 citations. Twenty-three studies met the inclusion criteria. Definitions were appraised using five criteria (with each scoring out of one): use of published citation, multi-disciplinarity, journal impact, definition comprehensibility, text readability. Most definitions scored low on citation (Mean ± SD: 0.22 ± 0.42), multi-disciplinarity (0.15 ± 0...

Globalization and Health, 2014

Background: With the failure of the latest vaccine trial, HVTN-505, HIV prevention efforts remain... more Background: With the failure of the latest vaccine trial, HVTN-505, HIV prevention efforts remain critical. Social and structural factors contributing to HIV and STI transmission include stigma regarding sexual violence, HIV infection and sexual orientation. For instance, HIV prevention and overall sexual health programs in Peru have been implemented yet key populations of youth (sex workers, male and transgender youth) continue to be overrepresented in new cases of HIV and STI. This suggests that interventions must take new directions and highlights the need for additional research. Discussion: While interdisciplinary, international research collaborations often are indicated as best practice in developing new knowledge in global health and an important component of the leadership in health systems, this does not mean they are free of challenges. In this debate we document our reflections on some of the challenges in developing an interdisciplinary and international research team to understand HIV and STI prevention priorities among youth in two culturally diverse cities in Peru: Lima, the capital city, and Ayacucho, in the Andean region. Summary: Rather than offering solutions we aim to contribute to the debate about the object and purpose of global health research in the context of developing international research partnerships that genuinely promote a reciprocal and bidirectional flow of knowledge between the Global South and the Global North, and researchers at intersections of these locations.

Advances in Research and Theory, 1994

DIAGNOSTIC REASONING AND MEDICAL EXPERTISE Vimla L. Patel, Jose F. Arocha, and David R. Kaufman I... more DIAGNOSTIC REASONING AND MEDICAL EXPERTISE Vimla L. Patel, Jose F. Arocha, and David R. Kaufman I. Introduction The study of medical cognition has been the subject of formal inquiry for more than 30 years. The term medical cognition refers to studies of cogni-tive ...

Studies in Fuzziness and Soft Computing, 2005

Background: The "applied" nature distinguishes applied sciences from theoretical sciences. To emp... more Background: The "applied" nature distinguishes applied sciences from theoretical sciences. To emphasize this distinction, we begin with a general, meta-level overview of the scientific endeavor. We introduce the knowledge spectrum and four interconnected modalities of knowledge. In addition to the traditional differentiation between implicit and explicit knowledge we outline the concepts of general and individual knowledge. We connect general knowledge with the "frame problem," a fundamental issue of artificial intelligence, and individual knowledge with another important paradigm of artificial intelligence, case-based reasoning, a method of individual knowledge processing that aims at solving new problems based on the solutions to similar past problems. We outline the fundamental differences between Medical Informatics and theoretical sciences and propose that Medical Informatics research should advance individual knowledge processing (case-based reasoning) and that natural language processing research is an important step towards this goal that may have ethical implications for patient-centered health medicine. Discussion: We focus on fundamental aspects of decision-making, which connect human expertise with individual knowledge processing. We continue with a knowledge spectrum perspective on biomedical knowledge and conclude that case-based reasoning is the paradigm that can advance towards personalized healthcare and that can enable the education of patients and providers. We center the discussion on formal methods of knowledge representation around the frame problem. We propose a context-dependent view on the notion of "meaning" and advocate the need for case-based reasoning research and natural language processing. In the context of memory based knowledge processing, pattern recognition, comparison and analogy-making, we conclude that while humans seem to naturally support the case-based reasoning paradigm (memory of past experiences of problem-solving and powerful case matching mechanisms), technical solutions are challenging. Finally, we discuss the major challenges for a technical solution: case record comprehensiveness, organization of information on similarity principles, development of pattern recognition and solving ethical issues. Summary: Medical Informatics is an applied science that should be committed to advancing patientcentered medicine through individual knowledge processing. Case-based reasoning is the technical solution that enables a continuous individual knowledge processing and could be applied providing that challenges and ethical issues arising are addressed appropriately.

The Oxford Handbook of Thinking and Reasoning, 2012

The practice of medicine requires art as well as science. The latter argues for a deeper understa... more The practice of medicine requires art as well as science. The latter argues for a deeper understanding of the mechanisms underlying disease processes and use of scientific evidence in making patient care decisions. The study of medical reasoning and thinking underlies much of medical cognition and has been the focus of research in cognitive science and artificial intelligence in medicine. Expertise and medical knowledge organization, the directionality of reasoning, and the nature of medical errors are intricately tied to thinking and decision-making processes in medicine. With the recent advancement of technology in medicine, technology-mediated reasoning and reasoning support systems will be a focus for future research. This chapter discusses these issues within historical and current research perspectives.

Social Science & Medicine, 1988

A study of reasoning about the cause and treatment of childhood diarrhoea by Maasai schooled and ... more A study of reasoning about the cause and treatment of childhood diarrhoea by Maasai schooled and unschooled mothers was carried out in Kenya, using a method of analysis developed within cognitive psychology. A dramatic difference in the conceptual structures of mothers' reasoning about both the cause and treatment of diarrhoea was found between the unschooled and schooled group. The unschooled mothers' explanation of diarrhoea was in terms of illness, resulting from social and moral factors. The knowledge structures generated showed global coherence. The schooled mothers explained diarrhoea with a series of quasi-biomedical facts about the disease with little or no connections between facts. The role of understanding the underlying disease processes for learning in health education is discussed in the context of Kenyan culture.

Social Science & Medicine, 1998

ÐThis paper presents research aimed at investigating high level comprehension and problem solving... more ÐThis paper presents research aimed at investigating high level comprehension and problem solving processes in children in two dierent countries, India and Colombia. To this end, we use a series of health-related cognitive tasks as assessment tools. In one study, we also examine children's performance on these cognitive tasks, in relation to their nutritional status and parasitic load. The ages of the children tested ranged from 2 through 14 years. The tasks were designed to assess comprehension of sequences, organization of concepts, understanding of health routines (hygiene practices) and evaluation of hypothesis and evidence. The results show that children approach the dierent tasks with a baggage of beliefs and local knowledge of the world which determines their reasoning process, their comprehension and their problems solving. The results are discussed in terms of cognitive assessment approaches, as applied to classroom instruction. Given that children construct their understanding of reality based on what they already know and that education does not take this into account, we recommend that assessment tools should be devised that can tap prior knowledge and understanding, such that this can be analyzed and understood in relation to knowledge taught in the classroom. Current educational assessment fails in such an endeavor.

Clinical practice guidelines (CPGs) are aimed at physicians of various degrees of knowledge and e... more Clinical practice guidelines (CPGs) are aimed at physicians of various degrees of knowledge and experience. The expected result of the use of guidelines is the standardization and homogenization of clinical practice (i.e., that the same clinical problem be diagnosed, treated, or managed similarly by different physicians). However, CPGs can be semantically very complex. In fact, many CPGs are composed of elaborate collections of prescribed procedures, sometimes involving the embedding of procedures within procedures or complicated temporal or causal relations among the various steps in a procedure. Furthermore, interpretation of CPGs involves the generation of inferences that are needed for correctly implementing the procedure prescribed by the guideline. The fact that interpretation requires making inferences makes CPGs highly ambiguous and therefore prone to different interpretations by different physicians. To overcome the inherent ambiguity of CPGs, physicians make use of their domain-specific knowledge as well as their general world knowledge. This knowledge helps disambiguate procedural steps and temporal or causal relations among steps. Unfortunately, it is also the source of the differences in CPG interpretation that the CPGs are intended to equalize. In this position paper, we argue that propositional analysis is an important tool in the

Memory & Cognition, 1990

This paper is concerned with factors that disrupt the pattern of forward reasoning characteristic... more This paper is concerned with factors that disrupt the pattern of forward reasoning characteristic of experts with accurate performance. Two experiments are described. In the first, the performances of cardiologists, psychiatrists, and surgeons in diagnostic explanation of a clinical problem in cardiology were examined. In the second, the performances of cardiologists and endocrinologists in diagnostic explanation of clinical problems within and outside their domains of expertise were examined. The performances of researchers and practicing physicians are also compared. The results of Experiment 1 replicated earlier results regarding the relationship between forward reasoning and accurate diagnosis. There were no differences in recall as a function of expertise. Experts did not show any bias toward using specific knowledge from their own areas of expertise. The results of Experiment 2 showed that the breakdown of forward reasoning was related to the structure of the task. In particular, nonsalient cues induced some backward reasoning even in subjects with accurate diagnoses. Some differences were also found between the types of explanation used by researchers and practitioners. The practitioners referred more to clinical components in their explanations, whereas the researchers focused more on the biomedical components. An important distinction made in rule-based models of problem solving involves the directionality of inferences.

Latin American Perspectives, 1998

Since July 4, 1991, a new constitution has allowed Colombians to exercise their citizenship by di... more Since July 4, 1991, a new constitution has allowed Colombians to exercise their citizenship by displaying cultural diversity rather than by concealing it as required by the previous political charter. Paradoxically, invisibility continues not only to impede full ethnic inclusion of Afro-Colombians but to aggravate ethnic asymmetries that, in turn, erode nonviolent coexistence among the black and Indian people who have shared portions of the Baud6 River valley (Department of Choco) for at least 150 years. Until the late 1980s, integration was the main strategy for achieving national unity in Latin America. It was argued that, by comparison with models based on state-enforced racial segregation such as the one applied earlier in the U.S. South, it resulted in more interethnic tolerance (De Carvalho, Doria, and Oliveira, 1995; de la Fuente, 1996; Harris et al., 1993). Nonetheless, after the 1960s, Indian and Afro-American political movements began to point out that amalgamation had resulted in the cultural annihilation of ethnic minorities and significant losses of ancestral territories. In response, countries such as Brazil and Nicaragua approved constitutions that legitimated ethnic diversity and its consequent territorial and political rights (Arocha, 1989). In Colombia, Indians and Afro-Colombians took part directly or indirectly in a National Constitutional Assembly that, in 1991, eliminated assimilationism.

Journal of the Learning Sciences, 1995

... Page 2. 356 AROCHA AND PATEL their training. ... A number of such strate-gies have been thoug... more ... Page 2. 356 AROCHA AND PATEL their training. ... A number of such strate-gies have been thought to play an important role in both scientific and everyday reasoning (Bruner, Goodnow, &amp; Austin, 1956; Dunbar &amp; Schunn, 1990; Kuhn, 1989; Patel &amp; Groen, 1986). ...

Journal of the American Medical Informatics Association, 2001

Medical informatics is a multidisciplinary field that draws on a range of other disciplines, such... more Medical informatics is a multidisciplinary field that draws on a range of other disciplines, such as computer science, information science and, more recently, the cognitive and social sciences. Medical informatics is increasingly recognized as being much more than the thin intersection of a science of computing and medical practice. 1 Cognitive science and studies of medical cognition meaningfully inform and shape design, development, and assessment of information systems and decision-support technology. 2 We present a set of exemplars that illustrate how methods and theories from cognitive science can be used to further these objectives. Technology is increasingly playing a central role in medical practice. As in most workplaces, a gulf exists between technologic artifacts and end users. Bridging this gulf necessitates both changes in the design of artifacts and the development and refinement of human competencies. 3 In addition, a host of issues that extend beyond the use of technology are of concern to investigators in medical informatics. These include the comprehension of medical information by health care personnel, the development of skill and models of competency for complex tasks, and the coordination of knowledge among persons with different backgrounds. Cognitive science can provide a framework for the analysis and modeling of complex human performance and thereby contribute toward these objectives. It can also provide insight into principles of system usability, 4-7 the process of medical judgment and decision making, 8 the training of physicians and end users, and the study of collaboration in the workplace. 9 This paper offers a primer on the aspects of medical cognition, briefly surveys pertinent literature, and provides a set of claims that can inform researchers in medical informatics. This primer is not intended to be comprehensive. It addresses a subset of issues that we view as particularly relevant. Areas such as decision making, perceptual diagnosis, and collaborative learning are addressed only briefly here. A survey of medical decision-making research, a vast area of considerable importance, would require an article unto itself. In fact, edited volumes provide extensive reviews of this area. 10,11