Benbassat J, Bachar-Bassan E
J Med Educ. 1984 Dec;59(12):951-6. doi: 10.1097/00001888-198412000-00005.
Medical students and board-certified general internists were presented with two written clinical simulations and asked to list their initial diagnostic hypotheses. Bronchial asthma and respiratory infection were among the three most frequently listed causes of a sudden shortness of breath in a young male, while malignancy, depression, and thyrotoxicosis were among the six most frequently listed causes of fatigue and loss of weight in a young woman. Junior medical students in the preclinical phase of the curriculum responded with fewer and less specific initial diagnostic hypotheses than did the internists. The number and specificity of the hypotheses advanced by senior medical students, who had completed the medical clerkship, were similar to those of the internists. However, the senior students advanced a wider range of diagnostic possibilities, some of which are rare or virtually nonexistent in the age groups of the patients in the simulations. These findings identify two deficiencies in students' diagnostic problem-solving: (a) lack of familiarity with alternative diagnostic possibilities and (b) poor ability to consider diagnostic hypotheses in terms of probabilities.
向医学生和获得董事会认证的普通内科医生展示了两个书面临床模拟案例，并要求他们列出最初的诊断假设。支气管哮喘和呼吸道感染是年轻男性突发呼吸急促最常列出的三个病因，而恶性肿瘤、抑郁症和甲状腺毒症是年轻女性疲劳和体重减轻最常列出的六个病因。处于课程临床前阶段的低年级医学生给出的最初诊断假设比内科医生少且不够具体。完成临床实习的高年级医学生提出的假设数量和特异性与内科医生相似。然而，高年级学生提出了更广泛的诊断可能性，其中一些在模拟案例中患者的年龄组中很少见或几乎不存在。这些发现指出了学生在诊断问题解决方面的两个缺陷：（a）对替代诊断可能性缺乏熟悉度，以及（b）根据概率考虑诊断假设的能力较差。
