This research utilized a structural analysis of final judgment and a process-tracing method to examine the effects of situational involvement and task complexity on information acquisition and the decision-making process. In addition, the predictive accuracy of the linear model in predicting drug choice across decision situations was assessed. A contingency model for the selection of decision strategies based on a cost/benefit principle was used as a framework in the study. A randomized mixed model factorial design was conducted in which a sample of forty-eight physicians, recruited from the University Medical Center at the University of Arizona, indicated their preferences and choices for hypothetical anti-infective drugs. Subjects were randomly assigned to experimental and control groups. Subjects in the experimental group were told via the written scenario to assume that his/her decision would be reviewed and evaluated by peers and (s)he would be asked to justify drug choice. No mention of peer review was made in the scenario used by the control group. Subjects in both groups were required to perform the two choice tasks and conjoint ranking task. The number of drug alternatives in a choice set was varied between three and six alternatives. The Mouselab program was used to monitor physicians' information acquisition behavior. The measures concerning the amount of information searched, order, duration, direction of search, and the chosen alternative were observed. The conjoint LINMAP program was used to estimate drug attribute importance weights. Results of the study provide support that the information acquisition and decision-making process is contingent on the characteristics of decision tasks. A significant number of subjects shifted from using compensatory to noncompensatory decision-making processes when task complexity increased. The study did not find support for the effects of situational involvement on the decision-making process. However, subjects in the two groups were found to differ in choice outcomes and the attention given to specific drug attribute information. Finally, the study found support for the robustness of the linear models in predicting drug choice across contexts.

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Medical professions associated with time pressured environments, incorporate apprenticeship as part of training. While our understanding of decision making has moved towards examining these environments, how does this knowledge apply to instruction in these contexts? / Specific reasoning strategies identified by Patel are useful in assessing medical instruction. Rasmussen's guidelines and Patel's protocol analytic methods are applied in this thesis to assess two time-pressured environments of a local hospital. In the medical and surgical intensive care unit, resident physician instruction and patient care co-occur withing the context of problem solving and decision making. / Differences between the two environments include a flattened hierarchy of communication, information exchange, and decision making content. Trainees approximated the proportion of directed reasoning strategies used by supervisors. Results are attributed to differences in knowledge-based solution strategy use, and medical domain structure. Implications for design of more guided apprenticeship programs is discussed.

This study examined how medical tutors used a tool from clinical practice known as the patient problem list to support students' clinical reasoning in a natural internal medicine ward setting. A grounded 2 case comparative study was conducted with 2 real patient case discussions by a tutor and 3 pre-clerkship students and a resident and 1 clerkship level student respectively. Codes that emerged by verbal analysis of the data were related to each other in a discourse map. In both cases evidence of cognitive apprenticeship teaching strategies and the patient problem list shaped and were shaped by a spiral model of increasingly elaborate shared knowledge. The patient problem list links tutor support to student education for practice with complex medical patients.

Following an initial observation that current North American books purporting to instruct their readers in the subject of medicine dislay broad variations both in their form as well as in their contents, an investigation was undertaken of eight such 'books of medical instruction': three textbooks of medicine and five popular home medical books. / Based on a semiotic analysis of these two kinds of books of medical instruction (i.e. an analysis of their constituent linguistic and non-linguistic signs), textbooks were distinguished from popular books on the levels of both form and contents. / With respect to form, textbook style was found to be formal and authoritative, hence high in accountability. Popular style on the other hand, was found to be informal and authoritarian, hence low in accountability. / With respect to contents, the two groups of books were found to differ on two accounts: (a) their scope (i.e. the kinds and numbers of topics addressed), and (b) the manner in which each group characteristically portrayed homo medicabilis (defined as 'man as the object of a medical description').

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