A cognitive perspective on medical expertise: Theory and implications

Academic Medicine

Volumn 65, Issue 10, 1990, Pages 611-621

  Schmidt, H G ^a   Norman, G R ^b   Boshuizen, H P A ^a  

^a MAASTRICHT UNIVERSITY   (Netherlands)

^b MCMASTER UNIVERSITY   (Canada)

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; CLINICAL PRACTICE; COGNITION; COMPETENCE; COMPUTER ANALYSIS; DIAGNOSIS; EDUCATION; ERROR; HUMAN; INFORMATION PROCESSING; MEDICAL EDUCATION; MEDICAL EXPERT; NORMAL HUMAN; ORGANIZATION AND MANAGEMENT; PERFORMANCE; PHYSICAL EXAMINATION; PRIORITY JOURNAL; PSYCHOLOGICAL ASPECT; SKILL; STANDARDIZATION; THEORETICAL STUDY;

CLINICAL COMPETENCE; CLINICAL PROTOCOLS; DIAGNOSIS; DIAGNOSTIC ERRORS; HUMAN; MEMORY; MENTAL PROCESSES; PHYSICIANS; PROBLEM SOLVING; QUALITY OF HEALTH CARE; STUDENTS, MEDICAL; TEACHING;

EID: 0025011741     PISSN: 10402446     EISSN: 1938808X     Source Type: Journal    
DOI: 10.1097/00001888-199010000-00001     Document Type: Article

References (53)

1. McGuire, C. H., and Babbott, D. Simulation Technique in the Measurement of Problem-Solving Skills. J. Educ. Measur. 4(1967):1-10.
2. Neufeld, V. R., and Barrows, H. S. The "McMaster Philosophy:" An Approach to Medical Education. J. Med. Educ. 49(1974):1040-1050.
3. Elstein, A. S., Shulman, L. S., and Sprafka, S. A. Medical Problem-Solving: An Analysis of Clinical Reasoning. Cambridge, Massachusetts: Harvard University Press, 1978.
4. Neufeld, V. R., Norman, G. R., Barrows, H. S., and Feightner, J. W. Clinical Problem-Solving by Medical Students: A Longitudinal and Cross-Sectional Analysis. Med. Educ. 15(1981):315-322.
5. Norman, G. R., Tugwell, P., Feightner, J. W., and Muzzin, L. J. Knowledge and Clinical Problem-Solving Ability. Med. Educ. 19(1985):344-356.
6. Maatsch, J. L., and Huang, R. L. An Evaluation of Four Alternative Theories of Clinical Competence. In Research in Medical Education: 1986. Proceedings of the Twenty-Fifth Annual Conference, pp. 69-74. Washington, D.C.: Association of American Medical Colleges, 1986.
7. Ronteltap, C. F. M., and Imbos, T. The Use of Knowledge in Diagnostic Problem-Solv-ing. Paper presented at the TICTAC Conference, Groningen, The Netherlands, 1989.
8. Clute, K. F. The General Practitioner. Toronto, Ontario, Canada: University of Toronto Press, 1963.
9. Peterson, O. L., Andrews, L. P., Spain, R. S., and Greenberg, B. G. An Analytical Study of North Carolina General Practice: 1953-1954. J. Med. Educ. 31, Part 2 (December 1956).
10. Marshall, J. Assessment of Problem-Solv-ing Ability. Med. Educ. 11(1977):329-334.
11. Friedman, M., Prywes, M., and Benbassat, J. J. Variability in Doctors' Problem-Solv-ing as Measured by Open-Ended Written Patient Simulations. Med. Educ. 23(1989):270-275.
12. Bligh, T. Written Simulation Scoring: A Comparison of Nine Systems. Paper presented at the American Educational Research Association meeting, New York, 1980.
13. Swanson, D. B., Norcini, J., and Grosso, L. Assessment of Clinical Competence: Written and Computer-Based Simulations. Assess. E?al. Higher Educ. 12(1987): 220-246.
14. Norman, G. R., Neufeld, V. R., Woodward, C. A., McConvey, G. A., and Walsh, A. Measuring Physicians' Performances by Standardized Patients. J. Med. Educ. 60(1985):925-934.
15. Friedman, R. B., et al. Experience with the Simulated Patient Physician Encounter. J. Med. Educ. 53(1978):825-830.
16. McLeskey, C. H., and Ward, R. J. Validity of Written Examinations. Anesthesiology 49(1978):224.
17. Grant, J., and Marsden, P. Primary Knowledge, Medical Education, and Consultant Expertise. Med. Educ. 22(1988): 746-753.
18. Schmidt, H. G., Boshuizen, H. P. A., and Hobus, P. P. M. Transitory Stages in the Development of Medical Expertise: The "Intermediate Effect" in Clinical Case Representation Studies. In Proc. 10th Conf. Cognitive Science Soc., pp. 139-145. Hillsdale, New Jersey: Erlbaum, 1988.
19. Kundel, H. L., Nodine, C. F., and Car-mody, D. Visual Scanning, Pattern Recognition and Decision Making in Pulmonary Nodule Detection. Invest. Radiol. 13(1978):175-181.
20. Norman, G. R., Brooks, L. R., Allen, S. W., and Rosenthal, D. The Development of Expertise in Dermatology. Arch. Dermatol. 125(1989):1063-1068.
21. Myers-Worsley, M., Johnston, W. A., and Simons, M. A. The Influence of Expertise on X-ray Image Processing. J. Exp. Psychol. Learn. Mem. Cogn. 14(1988):553-557.
22. Van der Vleuten, C. P. M., and Swanson, D. B. Assessment of Clinical Skills with Standardized Patients: The State of the Art. Teach. Learn. Med. 1990 (in press).
23. Perkins, D. N., and Salomon, G. Are Thinking Skills Context-Bound? Educ. Researcher 18(1989):16-25.
24. Chi, M. T. H., Glaser, R., and Farr, M. J. The Nature of Expertise. Hillsdale, New Jersey: Erlbaum, 1989.
25. Clancey, W. I. Methodology for Building Intelligent Tutoring Systems. In Methods and Tactics in Cognitive Science, W. Kintsch, et al., eds. Hillsdale, New Jersey: Erlbaum, 1984.
26. Weinstein, M. D., et al. Clinical Decision Analysis. Philadelphia, Pennsylvania: W. B. Saunders, 1980.
27. Slovic, P., Rorer, L. G., and Hoffman, P. J. Analyzing Use of Diagnostic Signs. Invest. Radio. 6(1971):18-26.
28. Allen, S. W., Brooks, L. R., and Norman, G. R. Effect of Prior Examples on Rule-based Diagnostic Performance. In Research in Medical Education: 1988. Proceedings of the Twenty-Fifth Annual Conference. Washington, D.C.: Association of American Medical Colleges, 1988.
29. Lakoff, G. Cognitive Models and Prototype Theory. In Concepts and Conceptual Development, U. Neisser, ed., pp. 63-102. Cambridge, England: Cambridge University Press, 1987.
30. Anderson, J. R. Cognitive Psychology and Its Implications. New York: Freeman, 1985.
31. Feltovich, P. J., and Barrows, H. S. Issues of Generality in Medical Problem Solving. In Tutorials in Problem-Based, Learning: A New Direction in Teaching the Health Professions, H. G. Schmidt and M. L. De Voider, eds., pp. 128-142. Assen, The Netherlands: Van Gorcum, 1984.
32. Boshuizen, H. P. A., Schmidt, H. G., and Coughlin, L. D. On the Application of Medical Basic Science Knowledge in Clinical Reasoning: Implications for Structural Knowledge Differences Between Experts and Novices. Proc. 10th Conf. Cogn. Sci. Soc., pp. 517-523. Hillsdale, New Jersey: Erlbaum, 1988.
33. Patel, V. L., Evans, D. A., and Groen, G. J. Biomedical Knowledge and Clinical Reasoning. In Cognitive Science in Medicine, D. A. Evans and V. L. Patel, eds., pp. 53-112. Cambridge, Massachusetts, MIT Press, 1988.
34. Claessen, H. F. A., and Boshuizen, H. P. A. Recall of Medical Information by Students and Doctors. Med. Educ. 19(1985):61-67.
35. Groen, G. J., and Patel, V. L. The Relationship Between Comprehension and Reasoning in Medical Expertise. In The Nature of Expertise, M. T. H. Chi, et al., eds., pp. 287-310. Hillsdale, New Jersey: Erlbaum, 1988.
36. Coughlin, L. D., and Patel, V. L. Text Comprehension and Expertise in the Domain of Medicine. Paper presented at the Annual Meeting of the American Educational Research Association, San Francisco, California, 1986.
37. Norman, G. R., Brooks, L. R., and Allen, S. W. Recall by Expert Medical Practitioners and Novices as a Record of Processing Attention. J. Exp. Psychol.: Learn. Mem. Cogn. 13(1989):1166-1174.
38. Schmidt, H. G., Hobus, P. P. M., Patel, V. L., and Boshuizen, H. P. A. Contextual Factors in the Activation of First Hypotheses: Expert-Novice Differences. Paper presented at the Annual Meeting of the American Educational Research Association, Washington, D.C., 1987.
39. Hobus, P. P. M., Hofstra, M. L., Boshuizen, H. P. A., and Schmidt, H. G. De context van de klatch als diagnosticum [The context of a complaint as a diagnostic tool]. Huisarts era Wetenschap. 31(1988): 261-267.
40. Hobus, P. P. M., Hofstra, M. L., Boshuizen, H. P. A., and Schmidt, H. G. Mental Representation of Prototypical Patients: Expert-Novice Differences. Paper presented at the First European Congress on Psychology, Amsterdam, 1989.
41. Bordage, G., and Zacks, R. The Structure of Medical Knowledge in the Memories of Medical Students and General Practitioners: Categories and Prototypes. Med. Educ. 18(1984):406-416.
42. Hassebrock, F., and Pretula, M. Autobiographical Memory in Medical Problem Solving. Paper presented at the American Educational Research Association Meeting, Boston, Massachusetts, 1990.
43. Van Rossum, H. J. M., and Bender, W. W. What Can Be Learned from a Boy with Acute Appendicitis? Persistent Effects of a Case Presentation on the Diagnostic Judgement of Family Doctors. Paper presented at the Fourth Ottawa Conference, Ottawa, Ontario, Canada, 1990.
44. Allen, S. W., and Brooks, L. R. Specializing the Operation of an Explicit Rule. J. Exper. Psychol.: General, 1990 (in press).
45. Whittlesea, B. W. A. Preservation of Specific Experiences in the Representation of General Knowledge. J. Exp. Psychol: Learn. Mem. Cogn. 13(1987):3-17.
46. Jacoby, L. L., Baker, J. G., and Brooks, L. R. The Priority of the Specific: Episodic Effects in Picture Identification. J. Exp. Psychol: Learn. Mem. Cogn. 15(1989): 275-281.
47. Van Rossum, H. J. M., Briet, E., Bender, W., and Meenders, A. E. The Transfer Effect of a Single Patient Demonstration on Diagnostic Judgement of Graduate Medical Students: Both Better and Worse. In Proceedings of the TICTAC Conference. Groningen, The Netherlands: TICTAC, 1989.
48. Larkin, J. H. The Role of Problem Representation in Physics. In Mental Models, D. Gentner and A. L. Stevens, eds., 75-98. Hillsdale, New Jersey: Erlbaum, 1983.
49. Waldrop, M. M. The Necessity of Knowledge. Science 223(1984):1279-1282.
50. Brooks, L. R. Decentralized Control of Categorization: The Role of Prior Processing Episodes. In Concepts and Conceptual Development: Ecological and Intellectual Factors in Categorization, U. Neisser, ed., pp. 141-174. Cambridge, England: Cambridge University Press, 1987.
51. Lesgold, A. M. Context Specific Requirements for Models for Expertise. In Cognitive Science in Medicine. D. A. Evans and V. L. Patel, eds., pp. 373-400. Cambridge, Massachusetts: MIT Press, 1989.
52. Norman, G. R. Reliability and Construct Validity of Some Cognitive Measures of Clinical Reasoning. Teach. Learn. Med. 1 (1989):194-199.
53. Case, S. M., Swanson, D. B., and Stillman, P. S. Evaluating Diagnostic Pattern Recognition: The Psychometric Characteristics of a New Item Format. In Research in Medical Education: 1988. Proceedings of the Twenty-Seventh Annual Conference, p. 3-8 Chicago, Illinois: Association of American Medical Colleges, 1986.