van de Wiel M W, Schmidt H G, Boshuizen H P
Skillslab, Faculty of Medicine, Maastricht University, Maastricht, The Netherlands.
Acad Med. 1998 Aug;73(8):894-900. doi: 10.1097/00001888-199808000-00015.
To investigate the differences between experts, intermediates, and novices in diagnosing and representing clinical cases under various time constraints.
Second-, fourth-, and sixth-year medical students, and internists studied, diagnosed, and recalled four clinical cases from internal medicine. Participants were allowed to study each case for either 3 minutes, 1 minute 15 seconds, or 30 seconds. The study replicated in most ways the 1993 clinical case recall study of Schmidt and Boshuizen.
As expected, diagnostic accuracy increased with level of expertise. However, this study failed to disclose the intermediate effect in clinical case recall that was found in the original study. Instead, a positive linear relation between expertise level and case recall was found. The discrepancy resulted from more elaborate recall by experts in the present study. Constraining processing time did not effect diagnostic accuracy, but equally affected the recall performances of the participants of all expertise levels. This contrasts with the earlier finding that experts' recall is independent of processing time.
Although it is unclear why the experts' case processing was more elaborate in the present study than in the earlier study, it must be concluded that expert medical knowledge is so flexibly organized that experts can easily represent clinical cases in either the encapsulated or the elaborated mode.
探讨专家、中级水平者和新手在不同时间限制下诊断和呈现临床病例的差异。
二年级、四年级和六年级医学生以及内科医生研究、诊断并回忆四个内科临床病例。参与者被允许以3分钟、1分15秒或30秒的时间来研究每个病例。该研究在大多数方面重复了1993年施密特和博舒伊曾的临床病例回忆研究。
正如预期的那样，诊断准确性随着专业水平的提高而增加。然而，本研究未能揭示原始研究中发现的临床病例回忆中的中级效应。相反，发现专业水平与病例回忆之间存在正线性关系。差异源于本研究中专家更详尽的回忆。限制处理时间并未影响诊断准确性，但同样影响了所有专业水平参与者的回忆表现。这与早期发现的专家回忆与处理时间无关形成对比。
虽然尚不清楚为何本研究中专家的病例处理比早期研究更详尽，但必须得出结论，专家医学知识的组织非常灵活，以至于专家能够轻松地以封装或详尽模式呈现临床病例。
