Title: Case instance (exemplar) versus disease/feature
association (abstraction) theories of medical diagnosis.
Frank Papa, DO, PhD
Director, Division of Integrative Medical Education
Department of Medical Education,
University of North Texas Health Sciences Center,
Texas College of Osteopathic Medicine,
Fort Worth 76107-2699, USA
American Psychological Annual Meetings, San Francisco, August 26, 2001.
For most of the twentieth century, the vast majority of clinical faculty and medical education researchers assumed that diagnostic competence was predicated upon the development of a generalizable skill called ‘problem solving’ (purportedly the most powerful tool in the physicians’ intellectual armamentarium). Over the past two decades however, a small number of medical education researchers have more formally posited that differential diagnosis: 1) is a ‘categorization’ or ‘classification’ task heavily dependent upon, 2) problem-specific knowledge.
Research into the cognitive issues underlying differential diagnosis has primarily been perceived as interesting only to ‘academicians’. However, clinical faculty and training program administrators are coming to realize that throughout the past 40 years, approximately 8 – 12% of autopsied patients die a premature death, while perhaps another 20% of ambulatory patients suffer potentially avoidable morbidity due to diagnostic errors. These previously unappreciated high morbidity and mortality levels have sparked calls for increased interest in, and the pragmatic application of formal cognitive theories directed at improving training in, and the assessment of diagnostic competency.
A number of relevant cognitive sciences-derived theories
have aided researchers in better understanding how problem-specific knowledge
is represented in memory, and, how metacognitive processes guide the
acquisition and utilization of patient-derived data and physician-derived
knowledge during differential diagnosis. This presentation will review the two
principal theoretical frameworks (exemplar and abstraction categorization
theories) which contemporary medical education researchers draw upon when
investigating, modeling and explaining the knowledge base representations and
cognitive processes underlying differential diagnosis (disease categorization).
However, rather than focusing upon the distinctions inherent to both
frameworks, the author will describe the assumptions shared by both frameworks
that could serve as the basis for better training, and assessing diagnostic
(categorization) capabilities.
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