Skip to main content
Log in

Examining the stability of experts’ clinical case processing: An experimental manipulation

  • Published:
Instructional Science Aims and scope Submit manuscript

Abstract

The present study was undertaken to examine the hypothesis that the intermediate effect in clinical case recall is partly explained by experts’ lower motivation to write down everything they remember when asked for free recall. Medical experts and students were presented with two clinical cases, which they had to read, diagnose, and recall. Participants received an instruction before processing the cases that aimed at minimizing motivation in one condition, and enhance motivation in another. A third condition received a standard instruction, comparable to previous clinical case representation studies. The results showed that medical experts’ clinical case processing mode is robust and insensitive to pressure induced by a social comparison instruction. In all conditions, recall data showed an intermediate effect, indicating encapsulated processing by the expert group. Moreover, there were no differences between the conditions in diagnostic accuracy, number of summaries in recall, and study time on the cases. Although experts showed that they were affected by the instruction, their processing mode remained stable over the three conditions. Expert physicians, even under conditions of considerable pressure, process clinical cases in an encapsulated mode.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  • V. Akre E. Falkum B.O. Hoftvedt O.G. Aasland (1997) ArticleTitleThe communication atmosphere between physician colleagues: Competitive perfectionism or supportive dialogue? A Norwegian study Social Science & Medicine 44 IssueID4 519–526

    Google Scholar 

  • G. Bordage (1994) ArticleTitleElaborated knowledge: A key to successful diagnostic thinking Academic Medicine 69 IssueID11 883–885 Occurrence Handle1:STN:280:ByqD3s3ks1A%3D Occurrence Handle7945684

    CAS  PubMed  Google Scholar 

  • Boshuizen, H.P.A. (1989). De ontwikkeling van medische expertise; een cognitief-psychologische benadering. Doctoral Dissertation. Haarlem: Thesis publishers

  • H.P.A. Boshuizen H.G. Schmidt (1992) ArticleTitleOn the role of biomedical knowledge in clinical reasoning by experts, intermediates and novices Cognitive Science 16 153–184 Occurrence Handle10.1016/0364-0213(92)90022-M

    Article  Google Scholar 

  • E.J.F.M. Custers H.P.A. Boshuizen H.G. Schmidt (1996) ArticleTitleThe influence of medical expertise, case typicality, and illness script component on case processing and disease probability estimates Memory and Cognition 24 IssueID3 384–399 Occurrence Handle1:STN:280:BymA3Mjntlc%3D

    CAS  Google Scholar 

  • A.D. Groot Particlede (1946) Het denken van den schaker. [Thinking Processes in Chess Players] The Hague The Netherlands: Noord-Holland

    Google Scholar 

  • A.D. De Groot (1965) Thought and Choice in Chess Mouton The Hague, The Netherlands

    Google Scholar 

  • K.A. Ericsson (1985) ArticleTitleMemory skill Canadian Journal of Psychology 39 IssueID2 188–231

    Google Scholar 

  • P.J. Feltovich H.S. Barrows (1984) Issues of generality in medical problem solving H.G. Schmidt M.L. De Volder (Eds) Tutorials in Problem-based Learning Van Gorcum Assen 128–142

    Google Scholar 

  • R.A. Hahn (1985) A world of internal medicine: Portrait of an internist R.A. Hahn A.D. Gaines (Eds) Physicians of Western Medicine: Anthropological Approaches to Theory and Practice D. Reidel Publishing Company Dordrecht, The Netherlands 51–111

    Google Scholar 

  • A.R. Jensen (1990) ArticleTitleSpeed of information processing in a calculating prodigy Intelligence 14 259–274 Occurrence Handle10.1016/0160-2896(90)90019-P

    Article  Google Scholar 

  • W. Kintsch J.G. Greeno (1985) ArticleTitleUnderstanding and solving word arithmetic problems Psychological Review 92 IssueID1 109–129 Occurrence Handle10.1037//0033-295X.92.1.109 Occurrence Handle1:STN:280:BiqC28novVY%3D Occurrence Handle3983303

    Article  CAS  PubMed  Google Scholar 

  • K.B. McKeithen J.S. Reitman H.H. Rueter S.C. Hirtle (1981) ArticleTitleKnowledge organization and skill differences in computer programmers Cognitive Psychology 13 307–325 Occurrence Handle10.1016/0010-0285(81)90012-8

    Article  Google Scholar 

  • Muzzin, L.J., Norman, G.R., Jacoby, L.L., Feightner, J.W., Tugwell, P. & Guyatt, G.H. (1982). Manifestations of expertise in recall of clinical protocols. In Proceedings of the 21st Conference on Research in Medical Education, pp. 163–168

  • G.R. Norman L.R. Brooks S.W. Allen (1989) ArticleTitleRecall by expert medical practitioners and novices as a record of processing attention Journal of Experimental Psychology: Learning, Memory, and Cognition 15 IssueID6 1166–1174

    Google Scholar 

  • Norman, G.R., Jacoby, L.L., Feightner, J.W. & Campbell, E.J.M. (1979). Clinical experience and the structure of memory. In Proceedings from the 18th Annual Conference on Research in Medical Education, pp. 214–217. Washington DC: American Association of Medical Colleges (AAMC)

  • Patel, V.L., Arocha, J.F. & Groen, G.J. (1986). Strategy selection and degree of expertise in medical reasoning. In C. Clifton, ed., Proceedings of the Eighth Annual Conference of the Cognitive Science Society, pp. 780–791. Hillsdale, NJ: Erlbaum

  • V.L. Patel D.A. Evans G.J. Groen (1989) Biomedical knowledge and clinical reasoning D.A. Evans V.L. Patel (Eds) Cognitive Science in Medicine Biomedical Modeling MIT Press Cambridge MA 53–112

    Google Scholar 

  • V.L. Patel D.A. Evans D.R. Kaufman (1991) ArticleTitleReasoning strategies and the use of biomedical knowledge by medical students Medical Education 24 129–136

    Google Scholar 

  • Patel, V.L. & Frederiksen, C.H. (1984). Propositional representations of medical texts by medical students and physicians. In Paper presented at the Annual Meeting of the American Educational Research Association, New Orleans, LA

  • V.L. Patel G.J. Groen (1986) ArticleTitleKnowledge based solution strategies in medical reasoning Cognitive Science 10 91–116 Occurrence Handle10.1016/S0364-0213(86)80010-6

    Article  Google Scholar 

  • V.L. Patel G.J. Groen C.H. Frederiksen (1986) ArticleTitleDifferences between medical students and doctors in memory for clinical cases Medical Education 20 3–9 Occurrence Handle1:STN:280:BimC2cnivF0%3D Occurrence Handle3951378

    CAS  PubMed  Google Scholar 

  • V.L. Patel D.R. Kaufman (1995) Clinical reasoning and biomedical knowledge: Implications for teaching J. Higgs M. Jones (Eds) Clinical Reasoning in the Health Professions Butterworth Heinemann Oxford, UK 117–128

    Google Scholar 

  • Patel, V.L., Medley-Mark, V. (1986). Relationship between representation of textual information and underlying problem representation in medicine. Cognitive Research Series, Montreal: McGill University, Centre for Medical Education. (CME86-CS1)

  • R.M.J.P. Rikers H.G. Schmidt H.P.A. Boshuizen (2000) ArticleTitleKnowledge encapsulation and the intermediate effect Contemporary Educational Psychology 25 150–166 Occurrence Handle10.1006/ceps.1998.1000 Occurrence Handle10753544

    Article  PubMed  Google Scholar 

  • R.M.J.P. Rikers H.G. Schmidt H.P.A. Boshuizen (2001) Effects of clinical case priming on the activation of encapsulated knowledge: Differences between medical experts and subexperts P. Columbus (Eds) Advances in Psychology Research NumberInSeriesVol. 4 Nova Science Publishers, Inc. Huntington, NY, US 1–31

    Google Scholar 

  • R.M.J.P. Rikers H.G. Schmidt H.P.A. Boshuizen (2002) ArticleTitleOn the constraints of encapsulated knowledge Clinical case representations by medical experts and subexperts Cognition and Instruction 20 IssueID1 27–45 Occurrence Handle10.1207/S1532690XCI2001_2

    Article  Google Scholar 

  • H.G. Schmidt H.P.A. Boshuizen (1992) Encapsulation of biomedical knowledge D.A. Evans V.L. Patel (Eds) Advanced models of Cognition for Medical Training and Practice Springer Verlag New York, NY

    Google Scholar 

  • H.G. Schmidt H.P.A. Boshuizen (1993) ArticleTitleOn the origin of intermediate effects in clinical case recall Memory and Cognition 21 338–351 Occurrence Handle1:STN:280:ByyA3c3lt1c%3D

    CAS  Google Scholar 

  • Schmidt, H.G., Boshuizen, H.P.A. & Hobus, P.P.M. (1988). Transitory stages in the development of medical expertise: The ‘intermediate effect’ in clinical case representation studies. In Proceedings of the Tenth Annual Conference of the Cognitive Science Society, pp. 139–145

  • G.J. Spilich G.T. Vesonder H.L. Chiesi J.F. Voss (1979) ArticleTitleText processing of domain-related information for individuals with high and low domain knowledge Journal of Verbal Learning & Verbal Behavior 18 275–290

    Google Scholar 

  • H.F. Stein (1990) American Medicine as Culture Westview Press Boulder, CO

    Google Scholar 

  • Van de Wiel, M. W. J., Boshuizen, H. P. A., & Schmidt, H. G. (1994, April). The influence of task instruction and lab data format on clinical case recall. In Paper presented at the Annual Meeting of the American Educational Research Association, New Orleans, LA

  • M.W.J. Van de Wiel H.P.A. Boshuizen H.G. Schmidt N.C. Schaper (1999) ArticleTitleThe explanation of medical concepts by expert physicians, clerks and advanced students Teaching and Learning in Medicine 11 IssueID3 153–163 Occurrence Handle10.1207/S15328015TL110306

    Article  Google Scholar 

  • M.W.J. Van de Wiel H.G. Schmidt H.P.A. Boshuizen (1998) ArticleTitleA failure to reproduce the intermediate effect in clinical case recall Academic Medicine 73 894–900 Occurrence Handle1:STN:280:DyaK1cvgvVSmtQ%3D%3D Occurrence Handle9736850

    CAS  PubMed  Google Scholar 

  • K.J. Vicente J.H. Wang (1998) ArticleTitleAn ecological theory of expertise effects in memory recall Psychological Review 105 IssueID1 33–57 Occurrence Handle1:STN:280:DyaK1c7ht1Wksg%3D%3D Occurrence Handle9450371

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Anique B.H. De Bruin.

Additional information

Part of this report was presented at the annual meeting of the American Educational Research Association, Seattle, Washington, April 1–5, 2001.

Rights and permissions

Reprints and permissions

About this article

Cite this article

De Bruin, A.B., Van De Wiel, M.W., Rikers, R.M. et al. Examining the stability of experts’ clinical case processing: An experimental manipulation. Instr Sci 33, 251–270 (2005). https://doi.org/10.1007/s11251-005-3598-8

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11251-005-3598-8

Keywords

Navigation