The Pedagogical Value of Adopting Multifaceted Approaches to Diagnostic Reasoning

Abstract

<p>There has been much debate in the medical education literature regarding the role of analytic and non-analytic reasoning strategies, but the impact of teaching one or the other strategy has yet to be directly tested. Analytical processes are those that entail the systematic and conscious consideration of features and their relationship to potential diagnoses - this is the form of clinical reasoning that has traditionally been advocated by educators. Alternatively, non-analytical processes are automatic, often unconscious means by which to arrive at a clinical diagnosis. One example of such a process is reliance on similarity to previously seen cases. The availability of these strategies are believed to increase with expertise, but debate exists regarding whether or not they are useful pedagogically. The purpose of these experiments was to examine the effectiveness of emphasizing particular decision-making processes during learning using an experimental methodology. Undergraduate Psychology students were trained to identify features on electrocardiograms (ECGs) and assign diagnoses. Experiment 1 focused mainly on understanding the role feature identification plays in decision-making, and whether instruction regarding how to organize the diagnostic features are beneficial. The purpose of experiment 2 was to determine the relative benefit of adopting a combination of feature driven and non-analytical strategies and contrastive instructions (i.e. being explicitly told to compare similarities and differences between diagnostic categories) at the time of training.</p>