Psychonomic Bulletin & Review

, Volume 24, Issue 5, pp 1398–1412 | Cite as

Watching diagnoses develop: Eye movements reveal symptom processing during diagnostic reasoning



Finding a probable explanation for observed symptoms is a highly complex task that draws on information retrieval from memory. Recent research suggests that observed symptoms are interpreted in a way that maximizes coherence for a single likely explanation. This becomes particularly clear if symptom sequences support more than one explanation. However, there are no existing process data available that allow coherence maximization to be traced in ambiguous diagnostic situations, where critical information has to be retrieved from memory. In this experiment, we applied memory indexing, an eye-tracking method that affords rich time-course information concerning memory-based cognitive processing during higher order thinking, to reveal symptom processing and the preferred interpretation of symptom sequences. Participants first learned information about causes and symptoms presented in spatial frames. Gaze allocation to emptied spatial frames during symptom processing and during the diagnostic response reflected the subjective status of hypotheses held in memory and the preferred interpretation of ambiguous symptoms. Memory indexing traced how the diagnostic decision developed and revealed instances of hypothesis change and biases in symptom processing. Memory indexing thus provided direct online evidence for coherence maximization in processing ambiguous information.


Eye movements Process tracing Memory indexing Diagnostic reasoning Coherence maximization 



This research was supported by the Swiss National Science Foundation (SNF) Grant PP00P1_157432 to the first author and German Research Foundation (DFG) Grants KR 1057/17-1 and JA 1761/7-1 to the second and third authors. The authors would like to thank Ricarda Fröde and Claudia Dietzel for their help in conducting the experiment, and Bettina von Helversen, Peter Shepherdson, Yvonne Oberholzer, and Tibor Petzoldt for helpful comments on an earlier version of the manuscript.

Supplementary material

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ESM 1 (DOCX 975 kb)


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© Psychonomic Society, Inc. 2017

Authors and Affiliations

  1. 1.Department of PsychologyUniversity of ZurichZurichSwitzerland
  2. 2.Department of PsychologyTechnische Universität ChemnitzChemnitzGermany

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