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Medical Problem Solving: An Analysis of Clinical Reasoning

About: The article was published on 1978-01-01 and is currently open access. It has received 1600 citations till now. The article focuses on the topics: Model-based reasoning.
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Journal ArticleDOI
TL;DR: Confirmation bias, as the term is typically used in the psychological literature, connotes the seeking or interpreting of evidence in ways that are partial to existing beliefs, expectations, or a h...
Abstract: Confirmation bias, as the term is typically used in the psychological literature, connotes the seeking or interpreting of evidence in ways that are partial to existing beliefs, expectations, or a h...

5,214 citations

Journal ArticleDOI
TL;DR: This article proposes an alternative framework to account for individual differences in attained professional development, as well as many aspects of age-related decline, based on the assumption that acquisition of expert performance requires engagement in deliberate practice and that continued deliberate practice is necessary for maintenance of many types of professional performance.
Abstract: The factors that cause large individual differences in professional achievement are only partially understood. Nobody becomes an outstanding professional without experience, but extensive experience does not invariably lead people to become experts. When individuals are first introduced to a professional domain after completing their education, they are often overwhelmed and rely on help from others to accomplish their responsibilities. After months or years of experience, they attain an acceptable level of proficiency and are able to work independently. Although everyone in a given domain tends to improve with experience initially, some develop faster than others and continue to improve during ensuing years. These individuals are eventually recognized as experts and masters. In contrast, most professionals reach a stable, average level of performance within a relatively short time frame and maintain this mediocre status for the rest of their careers. The nature of the individual differences that cause the large variability in attained performance is still debated. The most common explanation is that achievement in a given domain is limited by innate factors that cannot be changed through experience and training; hence, limits of attainable performance are determined by one’s basic endowments, such as abilities, mental capacities, and innate talents. Educators with this widely held view of professional development have focused on identifying and selecting students who possess the necessary innate talents that would allow them to reach expert levels with adequate experience. Therefore, the best schools and professional organizations nearly always rely on extensive testing and interviews to find the most talented applicants. This general view also explains age-related declines in professional achievement in terms of the inevitable reductions in general abilities and capacities believed to result from aging. In this article, I propose an alternative framework to account for individual differences in attained professional development, as well as many aspects of age-related decline. This framework is based on the assumption that acquisition of expert performance requires engagement in deliberate practice and that continued deliberate practice is necessary for maintenance of many types of professional performance. In order to contrast this alternative framework with the traditional view, I first describe the account based on innate talent. I then provide a brief review of the evidence on deliberate practice in the acquisition of expert performance in several performance domains, including music, chess, and sports. Finally, I review evidence from the acquisition and maintenance of expert performance in medicine and examine the role of deliberate practice in this domain.

2,492 citations

Journal ArticleDOI
Gary Klein1
TL;DR: The origins and contributions of the naturalistic decision making research approach, which has been used to improve performance through revisions of military doctrine, training that is focused on decision requirements, and the development of information technologies to support decision making and related cognitive functions.
Abstract: Objective: This article describes the origins and contributions of the naturalistic decision making (NDM) research approach. Background: NDM research emerged in the 1980s to study how people make decisions in real-world settings. Method: The findings and methods used by NDM researchers are presented along with their implications. Results: The NDM framework emphasizes the role of experience in enabling people to rapidly categorize situations to make effective decisions. Conclusion: The NDM focus on field settings and its interest in complex conditions provide insights for human factors practitioners about ways to improve performance. Application: The NDM approach has been used to improve performance through revisions of military doctrine, training that is focused on decision requirements, and the development of information technologies to support decision making and related cognitive functions.

2,224 citations

Book
01 Jan 1993
TL;DR: In this article, the authors present and elaborate on past models developed to explain this type of decision making and present a new perspective of naturalistic decision making, which they argue is unproductive since it is so heavily grounded in economics and mathematics.
Abstract: This book describes the new perspective of naturalistic decision making. The point of departure is how people make decisions in complex, time-pressured, ambiguous, and changing environments. The purpose of this book is to present and elaborate on past models developed to explain this type of decision making. The central philosophy of the book is that classical decision theory has been unproductive since it is so heavily grounded in economics and mathematics. The contributors believe there is little to be learned from laboratory studies about how people actually handle difficult and interesting tasks; therefore, the book presents a critique of classical decision theory. The models of naturalistic decision making described by the contributors were derived to explain the behavior of firefighters, business people, jurors, nuclear power plant operators, and command-and-control officers. The models are unique in that they address the way people use experience to frame situations and adopt courses of action. The models explain the strengths of skilled decision makers. Naturalistic decision research requires the examination of field settings, and a section of the book covers methods for conducting meaningful research outside the laboratory. In addition, since his approach has applied value, the book covers issues of training and decision support systems.

1,602 citations


Cites background from "Medical Problem Solving: An Analysi..."

  • ...The influence of precommitment on decision making has been docu­ mented by Alexander (1979), Elster (1977), Hickson, Butler, Cray, Mal­ lory, and Wilson (1986), Janis and Mann (1977), Soelberg (1967), Staw...

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Journal ArticleDOI
TL;DR: The principles of DP established in other domains, such as chess, music, typing, and sports, are drawn upon to provide insight into developing expert performance in medicine.
Abstract: Traditionally, professional expertise has been judged by length of experience, reputation, and perceived mastery of knowledge and skill. Unfortunately, recent research demonstrates only a weak relationship between these indicators of expertise and actual, observed performance. In fact, observed performance does not necessarily correlate with greater professional experience. Expert performance can, however, be traced to active engagement in deliberate practice (DP), where training (often designed and arranged by their teachers and coaches) is focused on improving particular tasks. DP also involves the provision of immediate feedback, time for problem-solving and evaluation, and opportunities for repeated performance to refine behavior. In this article, we draw upon the principles of DP established in other domains, such as chess, music, typing, and sports to provide insight into developing expert performance in medicine.

1,316 citations


Cites background or result from "Medical Problem Solving: An Analysi..."

  • ...In studies of medical doctors and nurses, it was typical to search for experts by using peer-nomination procedures among highly experienced professionals.(9,15,16)...

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  • ...Early studies were unable to establish superior accuracy of the peer-nominated best general physicians, when compared to a group of undistinguished physicians.(15,16) Similar findings were subsequently attained for clinical psychotherapists, where more advanced training and longer professional experience were unrelated to the quality and efficiency of treatment outcomes....

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