Yoon Jong-Sung, Boutis Kathy, Pecaric Martin R, Fefferman Nancy R, Ericsson K Anders, Pusic Martin V
Department of Psychology, University of South Dakota, Vermillion, SD, USA.
Dept. of Pediatrics, The Hospital for Sick Children, and University of Toronto, Toronto, Canada.
Adv Health Sci Educ Theory Pract. 2020 Oct;25(4):877-903. doi: 10.1007/s10459-020-09963-0. Epub 2020 Mar 5.
Models for diagnostic reasoning in radiology have been based on the observed behaviors of experienced radiologists but have not directly focused on the thought processes of novices as they improve their accuracy of image interpretation. By collecting think-aloud verbal reports, the current study was designed to investigate differences in specific thought processes between medical students (novices) as they learn and radiologists (experts), so that we can better design future instructional environments. Seven medical students and four physicians with radiology training were asked to interpret and diagnose pediatric elbow radiographs where fracture is suspected. After reporting their diagnosis of a case, they were given immediate feedback. Participants were asked to verbalize their thoughts while completing the diagnosis and while they reflected on the provided feedback. The protocol analysis of their verbalizations showed that participants used some combination of four processes to interpret the case: gestalt interpretation, purposeful search, rule application, and reasoning from a prior case. All types of processes except reasoning from a prior case were applied significantly more frequently by experts. Further, gestalt interpretation was used with higher frequency in abnormal cases while purposeful search was used more often for normal cases. Our assessment of processes could help guide the design of instructional environments with well-curated image banks and analytics to facilitate the novice's journey to expertise in image interpretation.
放射学中的诊断推理模型一直基于经验丰富的放射科医生的观察行为，但并未直接关注新手在提高图像解读准确性过程中的思维过程。通过收集出声思考的口头报告，本研究旨在调查医学生（新手）在学习过程中和放射科医生（专家）在特定思维过程上的差异，以便我们能够更好地设计未来的教学环境。七名医学生和四名接受过放射学培训的医生被要求对怀疑有骨折的小儿肘部X光片进行解读和诊断。在报告完对一个病例的诊断后，他们会立即得到反馈。参与者在完成诊断以及思考所提供的反馈时，被要求说出自己的想法。对他们言语表达的协议分析表明，参与者在解读病例时使用了四种过程的某种组合：格式塔解读、有目的搜索、规则应用和基于先前病例的推理。除了基于先前病例的推理外，所有类型的过程专家使用的频率都明显更高。此外，格式塔解读在异常病例中使用频率更高，而有目的搜索在正常病例中使用得更频繁。我们对这些过程的评估有助于指导教学环境的设计，通过精心策划的图像库和分析来促进新手在图像解读方面走向专业水平。
