THE DEVELOPMENT OF EXPERTISE IN DERMATOLOGY
THE DEVELOPMENT OF EXPERTISE IN DERMATOLOGY
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DOI：
10.1001/archderm.125.8.1063
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发表时间：
1989-08-01
影响因子：
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通讯作者：
MUZZIN, LJ
中科院分区：
文献类型：
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作者：
NORMAN, GR;ROSENTHAL, D;MUZZIN, LJ
为了检查皮肤科专业知识的发展，评估了五个专业知识水平的诊断准确性和反应时间。共100张载玻片，20种常见皮肤病各2张典型和3张非典型载玻片，分别呈现给以下各层次的6名受试者：临床前二年级医学生、最后一年级医学生、家庭医学住院医师、全科医生和皮肤科医生。医学学生的诊断准确率从21%上升到皮肤科医生的87%。正确的诊断与专业知识反应时间的减少有关，而错误与反应时间的急剧增加有关，并且在所有级别上都比正确的反应时间慢，这表明错误主要不是由于粗心或速度造成的。在所有更高水平的专业知识中，典型的幻灯片占诊断错误的恒定比例，专家继续在幻灯片上犯很大比例的错误，这对居民来说相对容易。结果显示，与任何将专业知识等同于掌握复杂规则的模型不同，但它们与提出专业知识等同于快速“模式识别”过程的专业知识模型一致，错误源于与先前类似示例的无意混淆。
To examine the development of expertise in dermatology, accuracy of diagnosis and response times of subjects at five levels of expertise were assessed. A total of 100 slides, 2 typical and 3 atypical slides from each of 20 common skin disorders, were presented to six subjects at each of the following levels: second-year preclinical medical students, final year medical students, residents in family medicine, general practitioners, and dermatologists. Accuracy of diagnosis rose from 21% for medical students to 87% of dermatologists. Correct diagnosis was associated with a decrease in response time with expertise, whereas errors were associated with a dramatic increase in response time, and was slower than correct response times at all levels, suggesting that errors do not result predominantly from carelessness or speed. Typical slides accounted for a constant proportion of diagnostic errors at all higher levels of expertise, and experts continued to make a significant proportion of errors on slides shown to be relatively easy for residents. The results are shown to be at variance with any model that equates expertise with the mastery of complex rules, but they are consistent with models of expertise that propose that expertise is equated with a rapid "pattern-recognition" process, and errors result from unintended confusion with previous similar examples.