Recently, there has been extensive research in the area of diagnostic expertise. The model of diagnostic reasoning and clinical expertise has been well documented (Patel et al., in press). This study attempts to extend this research in order to include therapeutic reasoning. Using the expert-novice paradigm, this study attempts to investigate the use of knowledge, specifically, both biomedical and clinical sciences, and the directionality of reasoning during decision making about patient management and therapeutic planning in respiratory medicine. / Subjects at four levels of expertise were given two clinical problems with the diagnosis and asked (a) to provide therapeutic plans, and (b) describe the underlying pathophysiological explanations of the diseases. Think-aloud protocols were audio-taped and analyzed using methods of protocol analysis. The results showed that the use of basic medical sciences increased as a function of expertise in the procedure-oriented decision-making tasks. The novices generated rule-based prototypical textbook descriptions based on the clinical information, and the diagnosis given in the task. In contrast, the experts' therapeutic responses showed a predominance of causal-level inferences, reflecting more backward-directed inferences than novices. Although both the novices and experts generated forward-directed inferences, the novices were unable to provide accurate and adequate explanations for their decisions. Finally, the pathophysiological explanations of the disease were generated from a different knowledge source than that used to develop therapeutic decisions. / The implications of these findings for development of theory of expertise and for education in the medical domain are discussed.
| Identifer | oai:union.ndltd.org:LACETR/oai:collectionscanada.gc.ca:QMM.41562 |
| Date | January 1994 |
| Creators | Chaturvedi, Rakesh K. |
| Contributors | Patel, Vimla L. (advisor) |
| Publisher | McGill University |
| 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 |
| Format | application/pdf |
| Coverage | Doctor of Philosophy (Department of Curriculum and Instruction.) |
| Rights | All items in eScholarship@McGill are protected by copyright with all rights reserved unless otherwise indicated. |
| Relation | alephsysno: 001401764, proquestno: NN94601, Theses scanned by UMI/ProQuest. |
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