Clinical case processing by medical experts and subexperts.

Abstract

Medical specialists, diagnosing cases within their domain of expertise, do not rely on intentional causal reasoning, in which they use explicit principles or rules of their domain. Rather, their reasoning has become an automatic process using schema-based knowledge. However, the difference between diagnoses made by medical specialists and diagnoses made by nonspecialists (i.e., subexperts) is unclear. In the present study, cardiologists (the experts), pulmonologists (the subexperts), and advanced medical students evaluated two clinical cases within the domain of cardiology. The cases were divided into four components (i.e., patient's history, physical examination, laboratory data, and additional findings) that were sequentially presented. The task was to study, diagnose, and recall the segmented clinical case description. It was expected that the subexperts and students, as a result of their lack of specific expertise, would focus on different case components than the experts would. However, results indicated that the main difference between experts and subexperts (and to a lesser extent, students) was not a difference in emphasis on case components, but the speed and accuracy of processing these case components.