Abstract
Background Previous studies have suggested an association between reasoning strategies and diagnostic success, but the influence on this relationship of variables such as question format and task difficulty, has not been studied. Our objective was to study the association between question format, task difficulty, reasoning strategies and diagnostic success. Methods Study participants were 13 Internal Medicine residents at the University of Calgary. Each was given eight problem-solving questions in four clinical presentations and were randomized to groups that differed only in the question format, such that a question presented as short answer (SA) to the first group was presented as extended matching (EM) to the second group. There were equal numbers of SA/EM questions and straightforward/difficult tasks. Participants performed think-aloud during diagnostic reasoning. Data were analyzed using multiple logistic regression. Results Question format was associated with reasoning strategies; hypothetico-deductive reasoning being used more frequently on EM questions and scheme-inductive reasoning on SA questions. For SA question, non-analytic reasoning alone was used more frequently to answer straightforward cases than difficult cases, whereas for EM questions no such association was observed. EM format and straightforward task increased the odds of diagnostic success, whereas hypothetico-deductive reasoning was associated with reduced odds of success. Conclusions Question format and task difficulty both influence diagnostic reasoning strategies and studies that examine the effect of reasoning strategies on diagnostic success should control for these effects. Further studies are needed to investigate the effect of reasoning strategies on performance of different groups of learners.
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References
Barrows, H. S., Norman, G. R., Neufeld, V. R., & Feightner, J. W. (1982). The clinical reasoning of randomly selected physicians in general medical practice. Clinlical and Investigative Medicine, 5, 49–55.
Brooks, L. R., Norman, G. R., & Allen, S. W. (1991). Role of specific similarity in a medical diagnostic task. Journal of Experimental Psychology General, 120, 278–287.
Coderre, S., Mandin, H., Harasym, P. H., & Fick, G. H. (2004). Diagnostic reasoning strategies and diagnostic success. Medical Education, 37, 695–703.
Elstein, A. S., Shulman, L. S., & Sprafka, S. A. (1978). Medical problem solving: An analysis of clinical reasoning. Cambridge, MA: Harvard University Press.
Eva K. W., Brooks L. R., & Norman, G. R. (2002). Forward reasoning as a hallmark of expertise in medicine: Logical, psychological, phenomenological inconsistencies. In S. P. Shohov (Ed.), Advances in psychological research (pp. 41–69). New York: Nova Science Publishers, Inc.
Hatala, R., Norman, G. R., & Brooks, L. R. (1999). Impact of a clinical scenario on accuracy of electrocardiogram interpretation. Journal of General Internal Medicine, 14, 126–129.
Hatala, R. A., Norman, G. R., & Brooks, L. R. (1996). The effect of clinical history on physicians’ ECG interpretation skills. Academic Medicine, 71, S68–S70.
Kulatunga-Moruzi, C., Brooks, L. R., & Norman, G. R. (2001). Coordination of analytic and similarity-based processing strategies and expertise in dermatological diagnosis. Teaching and Learning in Medicine, 13, 110–116.
Mandin, H., Jones, A., Woloschuk, W., & Harasym, P. (1997). Helping students learn to think like experts when solving clinical problems. Academic Medicine, 72, 173–179.
McLaughlin, K., Coderre, S., Mortis G., Fick, G. H., & Mandin, H. (2006). Can concept sorting provide a reliable, valid and sensitive measure of medical knowledge structure? Adv Health Sci Educ.
McLaughlin, K., Coderre, S., Mortis G., & Mandin, H. (2004). Scheme-inductive reasoning is associated with increased odds of diagnostic success in both experts and novices whereas non-analytical strategies are associated with reduced odds of success in novices. Educacion Medica, 7, 80.
McLaughlin, K., Lemaire J, & Coderre, S. (2005). Creating a reliable and valid blueprint for the internal medicine clerkship evaluation. Medical Teacher, 27, 544–547.
McLaughlin, K., & Mandin, H. (2002). Using “concept sorting” to study learning processes and outcomes. Academic Medicine, 77, 813–816.
Needham, D. R., & Begg, I. M. (1991). Problem-oriented training promotes spontaneous analogical transfer: Memory-oriented training promotes memory for training. Memory Cognition, 19, 534–557.
Norman, G. R., & Brooks, L. R. (1997). The non-analytical basis of clinical reasoning. Advances in Health Science Education: Theory and Practice, 2, 173–184.
Norman, G. R., & Feightner, J. W. (1981). A comparison of behaviour on simulated patients and patient management problems. Medical Education, 15, 26–32.
Norman, G. R., Feightner, J. W., Tugwell, P., Muzzin, L. J., & Guyatt, G. (1983). The generalizability of measures of clinical problem-solving. Proceedings of the Annual Conference Research in Medical Education, 22, 110–114.
Norman, G. R., Rosenthal, D., Brooks, L. R., Allen, S. W., & Muzzin, L. J. (1989). The development of expertise in dermatology. Archives Dermatology, 125, 1063–1068.
Patel, V., & Groen, G. (1986). Knowledge based solution strategies in medical reasoning. Cognitive Science, 10, 91–116.
Swanson, D., Holtman K. Z., Clauser B. E., & Sawhill A. J. (2005). Psychometric characteristics and response times for one-best-answer questions in relation to number and source of options. Academic Medicine, 80, S93–S96.
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Heemskerk, L., Norman, G., Chou, S. et al. The effect of question format and task difficulty on reasoning strategies and diagnostic performance in Internal Medicine residents. Adv in Health Sci Educ 13, 453–462 (2008). https://doi.org/10.1007/s10459-006-9057-8
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DOI: https://doi.org/10.1007/s10459-006-9057-8