Evidence of the preferential use of disease prototypes over case exemplars among early year one medical students prior to and following diagnostic training

Abstract

Background: Two core dual processing theory (DPT) System I constructs (Exemplars and Prototypes) were used to: 1) formulate a training exercise designed to improve diagnostic performance in year one medical students, and 2) explore whether any observed performance improvements were associated with preferential use of exemplars or prototypes. Methods: With IRB approval, 117 year one medical students participated in an acute chest pain diagnostic training exercise. A pre-and post-training test containing the same 27 case vignettes was used to determine if the subjects' diagnostic performance improved via training in both exemplars and prototypes. Exemplar and Prototype theory was also used to generate a unique typicality estimate for each case vignette. Because these estimates produce different performance predictions, differences in the subjects' observed performance would make it possible to infer whether subjects were preferentially using Exemplars or Prototypes. Results: Pre-vs. post-training comparison revealed a significant performance improvement; t = 14.04, p < 0.001, Cohen's d = 1.32. Pre-training, paired t-testing demonstrated that performance against the most typical vignettes > mid typical vignettes: t = 4.94, p < 0.001; and mid typical > least typical: t = 5.16, p < 0.001. Post-training, paired t-testing again demonstrated that performance against the most

Faculty Development Directed at Curricular Reforms Designed to Improve Patient Outcomes

“…Research at UNTHSC/TCOM involving computer-based, dual processing theory-driven approaches to DD training has demonstrated that first-and secondyear students and practicing physicians achieve improved DD accuracy. [14][15][16] Two additional semesters of AME coursework and II processing mechanisms involving pattern recognition and rule-based constructs) during case-based practice opportunities conducted in a small group, faculty-facilitated learning environment. The AME faculty now have the opportunity and challenge to organize and produce institutional review board-approved research protocols to determine whether these innovations are leading to improved DD performance.…”

What Makes Some Diseases More Typical than Others? A Survey on the Impact of Disease Characteristics and Professional Background on Disease Typicality

“…One of the authors (BH) designed the survey and distributed it to 254 health related professionals while they were attending university courses or seminars at the Faculty of Medicine, University of Oslo, during the spring terms of 2010 to 2014. The respondents were categorized as MD (42), RN (67), physiotherapists (22), psychologists (13), and others (52). The latter category encompassed dentists, biologists, epidemiologists, social scientists, philosophers, and professionals with backgrounds from other humanities.…”

Use of clinical simulation to improve diagnostic reasoning in nursing

“…Learning researchers have highlighted that dual processing theories are adequate references to understand the basic structures of knowledge and intellectual abilities, 3 because they recognize the existence of analytical and non-analytical processes. Considering the evidence that diagnostic reasoning in nursing uses and should use both processes, it has become a logical selection to adopt a dual processing theory as the theoretical framework to guide the methodology construction.…”

“…11 Dual processing theories are important for diagnostic reasoning in nursing, because diagnoses represent a category of phenomena that have a poorly defined nature, allowing the two processing systems to act concomitantly. 3,7 Indeed, nursing diagnoses have aspects that define them as poorly-defined phenomena/concepts, as follows: have few reference standards; need defining characteristics that would be the diagnostic criteria; and be linked with different concepts that are not synonyms, but are often used by some as if they were, such as human response, problem, need, among others.…”

“…For example, a diagnosis that has 10 defining characteristics could, in theory, produce more than 600 combinations of signs and symptoms. 3 The same would happen in nursing diagnoses in terms of combining signs and symptoms or risk factors.…”