Many researchers have failed to find a relationship between experience and
judgment accuracy. In this study the purpose was to understand the relationship
between experience and expertise in clinical judgment. Common sense suggests that
experienced subjects make better quality judgments, compared to novices. Clinical
judgments, however, are ill-structured and characterized by uncertainty; they take place
in a dynamic context, with delayed or nonexistent feedback and are difficult to learn.
Cognitive operations that translate "cues" (such as risk factors, signs, and
symptoms) into judgments are not fully understood. Cognitive constructs (conceptual
structure, sensitivity to patterns in data, and judgment process) and individual
differences in age, education, and experience were explored to identify their relationship
to judgment expertise. Indicators of judgment quality were: accuracy, consistency,
latency, confidence, calibration, and knowledge accessibility.
In phase 1 of this study, cues were identified that best predicted healing time for
258 surgical patients with abdominal incisions. In Phase 2, the subjects were 36 nurses
with a range of experience caring for surgical patients. Generating both quantitative and
qualitative data, subjects made judgments about incisional healing on the basis of
information from actual patients. Multidimensional scaling was used to reveal
conceptual structure, and lens modeling was applied to assess sensitivity to broad
patterns. An information board task with think-aloud protocols demonstrated judgment
process. The selection of tasks was based on their analysis- or intuition-inducing
features, using K. R. Hammond's (1990) cognitive continuum theory.
Experience accounted for a only a small proportion of variance in performance,
whereas confidence in judgment was more strongly related to experience. Taken
together, these findings replicated previous research. Protocol data showed that
metacognition, knowledge accessibility, and reflectivity increased with experience.
Conceptual structure predicted judgment accuracy under intuitive conditions. Support
was found for Dreyfus and Dreyfus' (1986) hypothesized transition in cognition, from
deliberate processing of discrete cues, to intuitive processing of patterns of cues
encoded in memories for specific cases.
This study has theoretical significance by adding to knowledge about clinical
judgment, and by increasing understanding of cognitive changes associated with
expertise. This study has practical significance in providing direction for the
development of teaching methods aimed to increase learning from experience in
probabilistic contexts.
| Identifer | oai:union.ndltd.org:LACETR/oai:collectionscanada.gc.ca:BVAU.2429/6277 |
| Date | 11 1900 |
| Creators | Christie, Lynda A. |
| Source Sets | Library and Archives Canada ETDs Repository / Centre d'archives des thèses électroniques de Bibliothèque et Archives Canada |
| Language | English |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
| Relation | UBC Retrospective Theses Digitization Project [http://www.library.ubc.ca/archives/retro_theses/] |
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