Hobus P P, Schmidt H G, Boshuizen H P, Patel V L
Department of Family Medicine, University of Limburg, Maastricht, The Netherlands.
Med Educ. 1987 Nov;21(6):471-6. doi: 10.1111/j.1365-2923.1987.tb01405.x.
According to Feltovich & Barrows (1984), the general frame used by medical experts to construct a mental representation of a particular patient problem contains a component part for those illness features that are associated with the acquisition of the illness. These 'enabling conditions' are related in several ways to the patient's disease. Examples are conditions like sex and age, or risk factors originating from work, behaviour and hereditary taint. Because of the sequential nature by which patient data become available during a clinical interview, contextual information is expected to play an important role in the generation of initial diagnostic hypotheses. To investigate the hypothesis that experienced doctors better utilize this kind of information, a group of 18 experts and 17 novices was confronted with 32 short case histories each presented on three slides: a portrait of the patient, the patient chart containing previous disease history, and a slide with the presenting complaint. It was hypothesized that differences in the number of correct diagnoses would emerge between the two groups, because the experts would use the contextual information, implicitly provided by picture and patient chart, in a more extensive way. If so, this would show in the amount of information that is explicitly recalled later. The data confirmed these predictions. The experts produced almost 50% more correct hypotheses as compared to the novices and were able to reproduce a larger amount of contextual information in particular information that was directly relevant to the patient's problem. Only the expert group showed a high correlation between accuracy of diagnoses and recall measures.
根据费尔托维奇和巴罗斯（1984年）的研究，医学专家构建特定患者问题心理表征时所使用的一般框架包含一个组成部分，用于那些与疾病获得相关的疾病特征。这些“促成条件”在几个方面与患者的疾病相关。例如性别和年龄等条件，或源自工作、行为和遗传污点的风险因素。由于在临床问诊过程中患者数据是按顺序可得的，情境信息预计在初始诊断假设的产生中发挥重要作用。为了研究经验丰富的医生是否能更好地利用这类信息这一假设，一组18名专家和17名新手面对32个简短病例史，每个病例史通过三张幻灯片呈现：患者的照片、包含既往病史的患者病历，以及一张列出当前主诉的幻灯片。据推测，两组之间在正确诊断数量上会出现差异，因为专家会更广泛地利用由图片和患者病历隐含提供的情境信息。如果是这样，这将体现在之后明确回忆出的信息量上。数据证实了这些预测。与新手相比，专家提出的正确假设多出近50%，并且能够再现更多的情境信息，尤其是与患者问题直接相关的信息。只有专家组在诊断准确性和回忆测量之间显示出高度相关性。
