MacPherson Institute for Leadership, Innovation, and Excellence in Teaching, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada.
McMaster Faculty of Health Sciences Program in Education Research, Innovation and Theory (MERIT), Hamilton, Canada.
Adv Health Sci Educ Theory Pract. 2021 Aug;26(3):811-825. doi: 10.1007/s10459-020-10023-w. Epub 2021 Jan 10.
Rapidly assessing how ill a patient is based on their immediate presentation-colloquially termed 'eyeballing' in practice-serves a vital role in acute care settings. Yet surprisingly little is known about how this diagnostic skill is learned or how it should be taught. Some authors have pointed to a dual-process model, suggesting that assessments of illness severity are driven by two distinct types of processing: an intuitive, fast, pattern recognition-like process (Type 1) that depends on many prior patient encounters and outcomes being stored in memory; and a deliberate, slow, analytic process (Type 2) characterized by additional data gathering, data scrutiny, or recollection of rules. But prior studies have supported a dual-process model for the assessment of illness severity only insofar as experienced clinicians chiefly displayed what was presumed to be Type 1 processing. Here we further explored a dual-process model by examining whether less experienced clinicians displayed both types of processing when assessing illness severity across a series of cases. Consistent with the model, a dissociation between Type 1 and Type 2 processing was observed through resident reports of deliberation, response times, and three eye tracking metrics associated with diagnostic expertise. We conclude by discussing potential implications for the training of this enigmatic diagnostic skill.
根据患者的即时表现快速评估其病情——在实践中俗称为“目测”——在急症护理环境中起着至关重要的作用。然而，人们对这种诊断技能是如何习得的，以及应该如何教授，知之甚少。一些作者指出了一种双重加工模型，该模型表明，对疾病严重程度的评估是由两种不同类型的加工驱动的：一种是直觉的、快速的、类似于模式识别的加工（第 1 型），它依赖于大量先前的患者遭遇和结果被储存在记忆中；另一种是深思熟虑的、缓慢的、分析性的加工（第 2 型），其特点是额外的数据收集、数据审查或规则回忆。但先前的研究仅在经验丰富的临床医生主要表现出第 1 型加工的情况下支持了疾病严重程度评估的双重加工模型。在这里，我们通过检查经验不足的临床医生在一系列病例中评估疾病严重程度时是否表现出两种类型的加工，进一步探索了双重加工模型。与该模型一致，通过居民对深思熟虑的报告、反应时间以及与诊断专业知识相关的三个眼动跟踪指标，观察到了第 1 型和第 2 型加工之间的分离。最后，我们讨论了这一神秘诊断技能培训的潜在影响。
