Coderre S, Mandin H, Harasym P H, Fick G H
Department of Medicine, Faculty of Medicine, University of Calgary, Foothills Hospital, 1403 29th Street NW, Calgary, Alberta T2N 2T9, Canada.
Med Educ. 2003 Aug;37(8):695-703. doi: 10.1046/j.1365-2923.2003.01577.x.
Cognitive psychology research supports the notion that experts use mental frameworks or "schemes", both to organize knowledge in memory and to solve clinical problems. The central purpose of this study was to determine the relationship between problem-solving strategies and the likelihood of diagnostic success.
Think-aloud protocols were collected to determine the diagnostic reasoning used by experts and non-experts when attempting to diagnose clinical presentations in gastroenterology.
Using logistic regression analysis, the study found that there is a relationship between diagnostic reasoning strategy and the likelihood of diagnostic success. Compared to hypothetico-deductive reasoning, the odds of diagnostic success were significantly greater when subjects used the diagnostic strategies of pattern recognition and scheme-inductive reasoning. Two other factors emerged as independent determinants of diagnostic success: expertise and clinical presentation. Not surprisingly, experts outperformed novices, while the content area of the clinical cases in each of the four clinical presentations demonstrated varying degrees of difficulty and thus diagnostic success.
These findings have significant implications for medical educators. It supports the introduction of "schemes" as a means of enhancing memory organization and improving diagnostic success.
认知心理学研究支持这样一种观点，即专家使用心理框架或“图式”来组织记忆中的知识并解决临床问题。本研究的核心目的是确定解决问题的策略与诊断成功可能性之间的关系。
收集出声思维记录，以确定专家和非专家在尝试诊断胃肠病学临床症状时所使用的诊断推理。
通过逻辑回归分析，研究发现诊断推理策略与诊断成功的可能性之间存在关联。与假设演绎推理相比，当受试者使用模式识别和图式归纳推理的诊断策略时，诊断成功的几率显著更高。另外两个因素成为诊断成功的独立决定因素：专业知识和临床表现。不出所料，专家的表现优于新手，而四种临床症状中每种临床病例的内容领域都表现出不同程度的难度，从而影响诊断成功率。
这些发现对医学教育工作者具有重要意义。它支持引入“图式”作为增强记忆组织和提高诊断成功率的一种手段。
