Advances in Health Sciences Education

, Volume 14, Supplement 1, pp 7–18

Thinking about diagnostic thinking: a 30-year perspective


DOI: 10.1007/s10459-009-9184-0

Cite this article as:
Elstein, A.S. Adv in Health Sci Educ (2009) 14(Suppl 1): 7. doi:10.1007/s10459-009-9184-0


This paper has five objectives: (a) to review the scientific background of, and major findings reported in, Medical Problem Solving, now widely recognized as a classic in the field; (b) to compare these results with some of the findings in a recent best-selling collection of case studies; (c) to summarize criticisms of the hypothesis-testing model and to show how these led to greater emphasis on the role of clinical experience and prior knowledge in diagnostic reasoning; (d) to review some common errors in diagnostic reasoning; (e) to examine strategies to reduce the rate of diagnostic errors, including evidence-based medicine and systematic reviews to augment personal knowledge, guidelines and clinical algorithms, computer-based diagnostic decision support systems and second opinions to facilitate deliberation, and better feedback.


Clinical judgment Problem solving Clinical reasoning Cognitive processes Hypothetico-deductive method Expertise Intuitive versus analytic reasoning 

Copyright information

© Springer Science+Business Media B.V. 2009

Authors and Affiliations

  1. 1.Department of Medical EducationUniversity of Illinois at ChicagoChicagoUSA

Personalised recommendations