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Open AccessArticle

Diagnostic Reasoning across the Medical Education Continuum

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Department of Medicine, VA Medical Center, Boise, ID 83702, USA
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Behavioral Informatics and Medical Education, University of Washington, Seattle, WA 98195, USA
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Leadership Studies, Gonzaga University, Spokane, WA 99258, USA
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Department of Nursing, Eagle Gate College, Murray, UT 84123, USA
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English Department, Boise State University, Boise, ID 83725, USA
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Santa Rosa Community-based Outreach Clinic, VA Medical Center, San Francisco, CA 95403, USA
*
Author to whom correspondence should be addressed.
Healthcare 2014, 2(3), 253-271; https://doi.org/10.3390/healthcare2030253
Received: 30 April 2014 / Revised: 10 June 2014 / Accepted: 20 June 2014 / Published: 15 July 2014
We aimed to study linguistic and non-linguistic elements of diagnostic reasoning across the continuum of medical education. We performed semi-structured interviews of premedical students, first year medical students, third year medical students, second year internal medicine residents, and experienced faculty (ten each) as they diagnosed three common causes of dyspnea. A second observer recorded emotional tone. All interviews were digitally recorded and blinded transcripts were created. Propositional analysis and concept mapping were performed. Grounded theory was used to identify salient categories and transcripts were scored with these categories. Transcripts were then unblinded. Systematic differences in propositional structure, number of concept connections, distribution of grounded theory categories, episodic and semantic memories, and emotional tone were identified. Summary concept maps were created and grounded theory concepts were explored for each learning level. We identified three major findings: (1) The “apprentice effect” in novices (high stress and low narrative competence); (2) logistic concept growth in intermediates; and (3) a cognitive state transition (between analytical and intuitive approaches) in experts. These findings warrant further study and comparison. View Full-Text
Keywords: undergraduate medical education; graduate medical education; emotional stress; narrative medicine; diagnostic reasoning; professional competence; curriculum; personal narratives undergraduate medical education; graduate medical education; emotional stress; narrative medicine; diagnostic reasoning; professional competence; curriculum; personal narratives
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Smith, C.S.; Hill, W.; Francovich, C.; Morris, M.; Robbins, B.; Robins, L.; Turner, A. Diagnostic Reasoning across the Medical Education Continuum. Healthcare 2014, 2, 253-271.

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