The clinical reasoning characteristics of diagnostic experts
The clinical reasoning characteristics of diagnostic experts
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诊断专家的临床推理特点
DOI：
10.1080/0142159031000100427
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发表时间：
2003
期刊：
影响因子：
4.7
通讯作者：
H. Alexander
中科院分区：
文献类型：
--
作者：
M. Groves;P. O’Rourke;H. Alexander
本研究的目的是识别和描述诊断专家的临床推理特征。一组21名经验丰富的全科医生被要求完成诊断思维量表（DTI）和一组10个临床推理问题（CRP），以评估他们的临床推理。对DTI和CRP进行评分，并根据其中所含错误的数量和类型检查每个GP的CRP反应模式。对这些数据的分析表明，六名全科医生能够使用比他们的同事少得多的临床信息做出正确的诊断。这些全科医生的解释错误也明显减少，但在DTI和CRP上的得分较低。此外，该分析表明，尽管在识别和解释相关临床信息时没有错误，但仍有超过20%的误诊发生。这些结果表明，这六个全科医生诊断效率，有效和准确地使用相对较少的临床数据，因此可以归类为诊断专家。他们还指出，误诊的一个主要原因是未能正确整合临床数据。我们认为，在推理过程中，这一步的重视程度的增加应证明有利于本科医学生的临床推理技能的发展。
The aim of this study was to identify and describe the clinical reasoning characteristics of diagnostic experts. A group of 21 experienced general practitioners were asked to complete the Diagnostic Thinking Inventory (DTI) and a set of 10 clinical reasoning problems (CRPs) to evaluate their clinical reasoning. Both the DTI and the CRPs were scored, and the CRP response patterns of each GP examined in terms of the number and type of errors contained in them. Analysis of these data showed that six GPs were able to reach the correct diagnosis using significantly less clinical information than their colleagues. These GPs also made significantly fewer interpretation errors but scored lower on both the DTI and the CRPs. Additionally, this analysis showed that more than 20% of misdiagnoses occurred despite no errors being made in the identification and interpretation of relevant clinical information. These results indicate that these six GPs diagnose efficiently, effectively and accurately using relatively few clinical data and can therefore be classified as diagnostic experts. They also indicate that a major cause of misdiagnoses is failure to properly integrate clinical data. We suggest that increased emphasis on this step in the reasoning process should prove beneficial to the development of clinical reasoning skill in undergraduate medical students.