Reasoning about therapeutic and patient management plans in respiratory medicine by physicians & medical students

• Main Author: Chaturvedi, Rakesh K.
• Other Authors: Patel, Vimla L. (advisor)
• Format: Others
• Language: en
• Published: McGill University 1994
• Subjects: Diagnosis; Respiratory organs > Diseases; Therapeutics
• Online Access: http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=41562

Recently, there has been extensive research in the area of diagnostic expertise. The model of diagnostic reasoning and clinical expertise has been well documented (Patel et al., in press). This study attempts to extend this research in order to include therapeutic reasoning. Using the expert-novice paradigm, this study attempts to investigate the use of knowledge, specifically, both biomedical and clinical sciences, and the directionality of reasoning during decision making about patient management and therapeutic planning in respiratory medicine. === Subjects at four levels of expertise were given two clinical problems with the diagnosis and asked (a) to provide therapeutic plans, and (b) describe the underlying pathophysiological explanations of the diseases. Think-aloud protocols were audio-taped and analyzed using methods of protocol analysis. The results showed that the use of basic medical sciences increased as a function of expertise in the procedure-oriented decision-making tasks. The novices generated rule-based prototypical textbook descriptions based on the clinical information, and the diagnosis given in the task. In contrast, the experts' therapeutic responses showed a predominance of causal-level inferences, reflecting more backward-directed inferences than novices. Although both the novices and experts generated forward-directed inferences, the novices were unable to provide accurate and adequate explanations for their decisions. Finally, the pathophysiological explanations of the disease were generated from a different knowledge source than that used to develop therapeutic decisions. === The implications of these findings for development of theory of expertise and for education in the medical domain are discussed.