Small worlds and medical expertise: implications for medical cognition and knowledge engineering

Kushniruk, André; Patel, Vimla L.; Marley, A. A. J.

doi:10.1016/s1386-5056(98)00044-6

Cited by 36 publications

(29 citation statements)

References 22 publications

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“…One of the earliest phases in the diagnostic process is the formulation of the working hypothesis [10]. Experienced clinicians are reported to have a more schematic reasoning, generating broader hypothesis and drawing on previous experiences to recognize patterns and clues in the neurological examination (“small worlds”) [11]. They organize diagnostic knowledge on the basis of resemblances between disease categories.…”

Section: Discussionmentioning

confidence: 99%

“…They organize diagnostic knowledge on the basis of resemblances between disease categories. Conversely, less experienced clinicians tend to use linear thinking to arrive quickly at a diagnosis, using a working hypothesis, which contains less common conditions [11]. There may be an increased inability to discern relevant information from the case, considering less common conditions that may present with unusual symptoms, with discounting and explaining away of data that disagrees with their initial hypothesis (mild confirmation bias).…”

Section: Discussionmentioning

confidence: 99%

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Increase in the Admission of Stroke Mimics after Change in Emergency Shifts

Vargas

Costa²,

Melo³

et al. 2017

Cerebrovasc Dis

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Background: In 2010, changes were made to the shift pattern of neurology residents for cover in the Emergency Department at a university hospital. This resulted in a decrease in the number of emergency hours worked by neurology specialists and allowed for a natural quasi-experiment. Aim: We aimed to evaluate if changes to the number of emergency hours worked by neurology residents and specialist neurologists, (intervention) altered the number or pattern of admitted stroke mimics (SMs). Methods: Observational retrospective study from January 2007 to December 2013. Time of intervention was set as August 2010. We used a segmented linear regression - ARIMA - to evaluate changes in the temporal pattern of admitted SMs. A statistical correlation between the number of emergency hours worked by neurology residents and the number of admitted SMs was calculated using the Pearson Correlation Coefficient. Results: Of the 2,552 patients admitted to the stroke unit, 290 were SMs (11.4%). After August 2010, there was an increase in the number of admitted SMs (p = 0.003). After 2010, the most frequent SM diagnosis changed from a psychiatric condition to peripheral vertigo. A positive correlation was found between the number of hours worked primarily by neurology residents and the number of admitted SMs (Pearson correlation coefficient = 0.94; p = 0.002). Conclusions: Changes in the pattern of Emergency Department shifts were associated with an increase in the rate of admitted SMs and with a higher number of mimics with a final diagnosis of peripheral vertigo.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Increase in the Admission of Stroke Mimics after Change in Emergency Shifts

Vargas

Costa²,

Melo³

et al. 2017

Cerebrovasc Dis

View full text Add to dashboard Cite

show abstract

“…Determination that a scheme-directed diagnostic reasoning strategy was used occurred by analysis of the verbal discourse using modified propositional analysis [24]. A proposition is defined as "the smallest unit of meaning that underlies the surface structure of a text" [25]. This analysis consisted of searching the examinees' discourse for key predetermined propositions that linked categories and thus provided evidence for chunking (i.e.…”

Section: Methodsmentioning

confidence: 99%

The impact of two multiple-choice question formats on the problem-solving strategies used by novices and experts

et al. 2004

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BackgroundPencil-and-paper examination formats, and specifically the standard, five-option multiple-choice question, have often been questioned as a means for assessing higher-order clinical reasoning or problem solving. This study firstly investigated whether two paper formats with differing number of alternatives (standard five-option and extended-matching questions) can test problem-solving abilities. Secondly, the impact of the alternatives number on psychometrics and problem-solving strategies was examined.MethodsThink-aloud protocols were collected to determine the problem-solving strategy used by experts and non-experts in answering Gastroenterology questions, across the two pencil-and-paper formats.ResultsThe two formats demonstrated equal ability in testing problem-solving abilities, while the number of alternatives did not significantly impact psychometrics or problem-solving strategies utilized.ConclusionsThese results support the notion that well-constructed multiple-choice questions can in fact test higher order clinical reasoning. Furthermore, it can be concluded that in testing clinical reasoning, the question stem, or content, remains more important than the number of alternatives.

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“…6 One of the ways that an expert clinician generates a diagnosis is by taking advantage of the natural groupings of symptoms and using the similarities in these groupings to form a diagnosis. Kushniruk et al (1998), in fact, have speculated that clinicians create what they refer to as "small worlds" or theories in the process of collecting signs and symptoms together to form a diagnosis. As they describe, "the 'small world' hypothesis…states that expert physicians organize knowledge on the basis of similarities between disease categories, forming numerous small worlds which consist of subsets of logically related diseases and their distinguishing features" (p. 256).…”

Section: Trained Judgment: Expertisementioning

confidence: 99%

The Role of Signs or Symptoms

Barofsky¹

2011

Quality

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The focus of this chapter is on the complex relationship between signs and symptoms, as an analog and therefore continuation of my discussion of the relationship between objective and subjective indicators. I discuss the figurative language used to express signs and symptoms, and a history of the development of the concept of objectivity. A final major topic covers the role of subjectivity in clinical medicine, and includes a discussion of the difference between clinimetric and psychometric assessments.

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Small worlds and medical expertise: implications for medical cognition and knowledge engineering

Cited by 36 publications

References 22 publications

Increase in the Admission of Stroke Mimics after Change in Emergency Shifts

Increase in the Admission of Stroke Mimics after Change in Emergency Shifts

The impact of two multiple-choice question formats on the problem-solving strategies used by novices and experts

The Role of Signs or Symptoms

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