Department of Medical Education, Southern Illinois University School of Medicine, Springfield, Illinois 62794-9681, USA.
Med Educ. 2013 Mar;47(3):309-16. doi: 10.1111/medu.12096.
The process whereby medical students employ integrated analytic and non-analytic diagnostic strategies is not fully understood. Analysing academic performance data could provide a perspective complementary to that of laboratory experiments when investigating the nature of diagnostic strategy. This study examined the performance data of medical students in an integrated curriculum to determine the relative contributions of biomedical knowledge and clinical pattern recognition to diagnostic strategy.
Structural equation modelling was used to examine the relationship between biomedical knowledge and clinical cognition (clinical information gathering and interpretation) assessed in Years 1 and 2 of medical school and their relative contributions to diagnostic justification assessed at the beginning of Year 4. Modelling was applied to the academic performance data of 133 medical students who received their md degrees in 2011 and 2012.
The model satisfactorily fit the data. The correlation between biomedical knowledge and clinical cognition was low-moderate (0.26). The paths between these two constructs and diagnostic justification were moderate and slightly favoured biomedical knowledge (0.47 and 0.40 for biomedical knowledge and clinical cognition, respectively).
The findings suggest that within the first 2 years of medical school, students possessed separate, but complementary, cognitive tools, comprising biomedical knowledge and clinical pattern recognition, which contributed to an integrated diagnostic strategy at the beginning of Year 4. Assessing diagnostic justification, which requires students to make their thinking explicit, may promote the integration of analytic and non-analytic processing into diagnostic strategy.
医学生运用综合分析和非分析诊断策略的过程尚未完全了解。分析学业成绩数据可以为实验室实验提供一种互补的视角，从而有助于研究诊断策略的本质。本研究通过分析综合课程中学生的表现数据，确定生物医学知识和临床模式识别对诊断策略的相对贡献。
结构方程模型用于检验医学生在医学院一年级和二年级所评估的生物医学知识和临床认知（临床信息收集和解释）与四年级初评估的诊断推理之间的关系，以及它们对诊断推理的相对贡献。该模型应用于 2011 年和 2012 年获得医学博士学位的 133 名医学生的学业成绩数据。
模型很好地拟合了数据。生物医学知识和临床认知之间的相关性为低到中等（0.26）。这两个结构之间的路径是中度的，略微偏向生物医学知识（生物医学知识和临床认知的路径分别为 0.47 和 0.40）。
研究结果表明，在医学院的头两年，学生拥有独立但互补的认知工具，包括生物医学知识和临床模式识别，这些认知工具为四年级初的综合诊断策略提供了支持。评估诊断推理需要学生明确自己的思维过程，这可能会促进分析和非分析处理的整合，进而促进诊断策略的形成。
