Gale J, Marsden P
Med Educ. 1982 Jan;16(1):22-6. doi: 10.1111/j.1365-2923.1982.tb01214.x.
The diagnostic thinking process is often described as one of hypothesis generation and testing. Yet descriptions of the clinical problem solver's thinking prior to generation of the first diagnostic hypothesis are lacking. This paper reports a study of this phase in students, house officers and registrars. Theories of pattern recognition are seriously questioned. It is shown that these subjects make immediate active interpretative or evaluative responses to initial items of clinical information elicited. These responses cannot be described as 'diagnostic hypotheses', but are important working interpretations. Implications for teaching are discussed.
诊断思维过程通常被描述为一个提出假设并进行检验的过程。然而，目前缺乏对临床问题解决者在提出第一个诊断假设之前的思维描述。本文报告了一项针对学生、住院医生和专科住院医生这一阶段的研究。模式识别理论受到了严重质疑。研究表明，这些受试者会对所引出的临床信息初始项立即做出积极的解释性或评估性反应。这些反应不能被描述为“诊断假设”，但却是重要的工作性解释。文中还讨论了该研究对教学的启示。
