CONTEXTUAL FACTORS IN THE ACTIVATION OF 1ST DIAGNOSTIC HYPOTHESES - EXPERT NOVICE DIFFERENCES
CONTEXTUAL FACTORS IN THE ACTIVATION OF 1ST DIAGNOSTIC HYPOTHESES - EXPERT NOVICE DIFFERENCES
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DOI：
10.1111/j.1365-2923.1987.tb01405.x
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发表时间：
1987-11-01
影响因子：
6
通讯作者：
PATEL, VL
中科院分区：
文献类型：
--
作者：
HOBUS, PPM;SCHMIDT, HG;PATEL, VL
根据Feltovich & Barrows（1984）的说法，医学专家用来构建特定患者问题的心理表征的一般框架包含与疾病获得相关的疾病特征的组成部分。这些“有利条件”在几个方面与患者的疾病有关。例如，性别和年龄等条件，或源于工作、行为和遗传污点的风险因素。由于患者数据在临床访谈期间变得可用的顺序性质，预期上下文信息在初始诊断假设的生成中发挥重要作用。为了研究有经验的医生更好地利用这类信息的假设，一组18名专家和17名新手面对32个简短的病例，每个病例用三张幻灯片展示：一张病人的肖像，一张包含既往病史的病人图表，一张有主诉的幻灯片。据推测，两组之间正确诊断的数量会出现差异，因为专家会以更广泛的方式使用图片和患者图表隐含提供的上下文信息。如果是这样的话，这将显示在稍后显式调用的信息量中。数据证实了这些预测。与新手相比，专家产生了近50%的正确假设，并且能够再现大量的上下文信息，特别是与患者问题直接相关的信息。只有专家组的诊断准确性和回忆测量之间存在高度相关性。
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.