Novice Diagnostic Reasoning in Medicine: Accounting for Evidence
Abstract
This study investigated the strategies used by beginning, intermediate, and advanced medical students when solving clinical cases containing inconsistent data. Written clinical cases were used in which the initial patient data suggested a very common and prototypical disease. Subsequent data in the cases were inconsistent with this first suggestion. The cases were presented on a computer so that the subjects had the opportunity to reason aloud about the evidence. Verbal protocols were collected and analyzed. Our results showed that the beginning students generated the suggested hypothesis and either ignored or reinterpreted the inconsistent evidence to fit their initial hypotheses. Advanced novices generated several hypotheses with a similar underlying problem; this allowed them to narrow their initial hypothesis set in the face of inconsistent evidence and make fewer data reinterpretations. Intermediate novices showed a similar pattern but failed to change their hypotheses with inconsistent data. They maintained several hypotheses of a diverse nature concurrently, without evaluating them efficiently. They showed a deterioration in performance—commonly known as the intermediate effect—which we interpreted as the result of a process of knowledge reorganization that interferes with problem solving. Results are discussed in terms of change in reasoning strategies as a function of the type of learning in medical school.
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Participants trained in PBL retained the backward-directed reasoning pattern, but did not seem to acquire forward-directed reasoning, which is a hallmark of expertise.
“Arocha and Patel (1995) found that participants trained in PBL retained the backward-directed reasoning pattern, but did not seem to acquire forward-directed reasoning, which is a hallmark of expertise.”
From Why Minimal Guidance During Instruction Does Not Work: An Analysis of the Failure of Constructivist, Discovery, Problem-Based, Experiential, and Inquiry-Based Teaching (2006) · cites this paper as Arocha and Patel (1995)
Arocha and Patel (1995) concluded that the negative results can be accounted for by the effect of splitting of attention resources and the high working memory load on schema acquisition during problem solving.
“Arocha and Patel (1995) concluded that the negative results can be accounted for by the effect of splitting of attention resources and the high working memory load on schema acquisition during problem solving.”
From Why Minimal Guidance During Instruction Does Not Work: An Analysis of the Failure of Constructivist, Discovery, Problem-Based, Experiential, and Inquiry-Based Teaching (2006) · cites this paper as Arocha and Patel (1995)
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Self-citation
- Authors
- Arocha, J. F., & Patel, V. L.
- Affiliations
- McGill University (CA)
- Arizona State University (US)
- Venue
- Journal of the Learning Sciences
- Publisher
- Informa UK Limited
- Published
- 1995-10
- Volume
- 4
- Issue
- 4
- Pages
- 355-384
- ISSN
- 1050-8406 (ISSN-L)
- 1532-7809
- OpenAlex
- W2009533928
- Cited by
- 44
- References
- 17
- Citations by year
- 2025: 1 · 2024: 2 · 2023: 5 · 2021: 1 · 2019: 1 · 2018: 2 · 2017: 3 · 2016: 2 · 2015: 4 · 2014: 1 · 2013: 2 · 2012: 2
- FWCI
- 0.55
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of the Learning Sciences (publishedVersion)
- Funders
- American Educational Research Association
- Medical Research Council Canada
- Topics
- Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Innovations in Medical Education
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Visual and Cognitive Learning Processes
- Keywords
- diagnostic reasoning, medical students, intermediate effects, hypothesis generation, hypothesis revision, verbal protocols, clinical case solving, knowledge restructuring, medical education
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