Thinking about diagnostic thinking: a 30-year perspective
Abstract
This paper has five objectives: (a) to review the scientific background of, and major findings reported in, Medical Problem Solving, now widely recognized as a classic in the field; (b) to compare these results with some of the findings in a recent best-selling collection of case studies; (c) to summarize criticisms of the hypothesis-testing model and to show how these led to greater emphasis on the role of clinical experience and prior knowledge in diagnostic reasoning; (d) to review some common errors in diagnostic reasoning; (e) to examine strategies to reduce the rate of diagnostic errors, including evidence-based medicine and systematic reviews to augment personal knowledge, guidelines and clinical algorithms, computer-based diagnostic decision support systems and second opinions to facilitate deliberation, and better feedback.
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Clinicians may leverage external resources, such as clinical guidelines or second opinions, to inform their decision-making.
“Beyond internal processes, clinicians may also leverage external resources, such as clinical guidelines or second opinions, to inform their decision-making34.”
From Large Language Models lack essential metacognition for reliable medical reasoning (2025) · cites this paper as [34]
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Large Language Models lack essential metacognition for reliable medical reasoning
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- Authors
- Elstein, A. S.
- Affiliations
- University of Illinois Chicago (US)
- Corresponding author
- Elstein, Arthur S.
- Venue
- Advances in Health Sciences Education
- Published
- 2009-08-11
- Volume
- 14
- Issue
- S1
- Pages
- 7-18
- ISSN
- 1382-4996 (ISSN-L)
- 1573-1677
- OpenAlex
- W2114674317
- Cited by
- 205
- References
- 57
- Citations by year
- 2026: 2 · 2025: 6 · 2024: 4 · 2023: 9 · 2022: 13 · 2021: 9 · 2020: 23 · 2019: 17 · 2018: 15 · 2017: 13 · 2016: 15 · 2015: 15 · 2014: 10 · 2013: 21 · 2012: 16
- FWCI
- 8.01
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Advances in Health Sciences Education (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Michigan State University
- Topics
- Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
- Health Sciences › Health Professions › General Health Professions › Health Sciences Research and Education
- Health Sciences › Medicine › Health Informatics › Artificial Intelligence in Healthcare and Education
- Keywords
- diagnostic reasoning, clinical problem solving, clinical experience, prior knowledge, diagnostic errors, evidence-based medicine, systematic reviews, clinical guidelines, clinical algorithms, second opinion, feedback, case studies
- MeSH terms
- Algorithms, Cognition, Diagnostic Errors, Feedback, Humans, Judgment, Problem Solving, Guidelines as Topic, Evidence-Based Medicine
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