Assistant Professor of Medicine, The Henry M Jackson Foundation for the Advancement of Military Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
Professor of Medicine and Pathology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
Diagnosis (Berl). 2020 Aug 27;7(3):273-280. doi: 10.1515/dx-2019-0103.
Background The literature suggests that affect, higher-level cognitive processes (e.g. decision-making), and agency (the capacity to produce an effect) are important for reasoning; however, we do not know how these factors respond to context. Using situated cognition theory as a framework, and linguistic tools as a method, we explored the effects of context specificity [a physician seeing two patients with identical presentations (symptoms and findings), but coming to two different diagnoses], hypothesizing more linguistic markers of cognitive load in the presence of contextual factors (e.g. incorrect diagnostic suggestion). Methods In this comparative and exploratory study, 64 physicians each completed one case with contextual factors and one without. Transcribed think-aloud reflections were coded by Linguistic Inquiry and Word Count (LIWC) software for markers of affect, cognitive processes, and first-person pronouns. A repeated-measures multivariate analysis of variance was used to inferentially compare these LIWC categories between cases with and without contextual factors. This was followed by exploratory descriptive analysis of subcategories. Results As hypothesized, participants used more affective and cognitive process markers in cases with contextual factors and more I/me pronouns in cases without. These differences were statistically significant for cognitive processing words but not affective and pronominal words. Exploratory analysis revealed more negative emotions, cognitive processes of insight, and third-person pronouns in cases with contextual factors. Conclusions This study exposes linguistic differences arising from context specificity. These results demonstrate the value of a situated cognition view of patient encounters and reveal the utility of linguistic tools for examining clinical reasoning.
背景 文献表明，情感、高级认知过程（例如决策）和能动性（产生影响的能力）对推理很重要；然而，我们不知道这些因素如何响应上下文。我们使用情境认知理论作为框架，语言工具作为方法，探索了上下文特异性的影响[医生看到两个具有相同表现（症状和发现）的患者，但得出两个不同的诊断]，假设在存在上下文因素（例如错误的诊断建议）的情况下会有更多认知负荷的语言标记。 方法 在这项比较性和探索性研究中，64 名医生每人完成了一个有上下文因素的案例和一个没有上下文因素的案例。通过语言探究和词汇计数（LIWC）软件对深思熟虑的反思进行了编码，以标记情感、认知过程和第一人称代词。使用重复测量多元方差分析来推断有和没有上下文因素的案例之间这些 LIWC 类别之间的差异。随后对亚类进行了探索性描述性分析。 结果 正如假设的那样，参与者在有上下文因素的案例中使用了更多的情感和认知过程标记，而在没有上下文因素的案例中则使用了更多的 I/me 代词。这些差异在认知加工词方面具有统计学意义，但在情感词和代词方面则没有。探索性分析表明，有上下文因素的案例中出现了更多的负面情绪、认知洞察过程和第三人称代词。 结论 这项研究揭示了由上下文特异性引起的语言差异。这些结果证明了患者就诊情境认知观点的价值，并揭示了语言工具在检查临床推理方面的实用性。
