Clinical reasoning: The relative contribution of identification, interpretation and hypothesis errors to misdiagnosis

Groves, M., O'Rourke, P., & Alexander, Heather (2003) Clinical reasoning: The relative contribution of identification, interpretation and hypothesis errors to misdiagnosis. Medical Teacher, 25(6), pp. 621-625.

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The aim of this study was to identify and describe the types of errors in clinical reasoning that contribute to poor diagnostic performance at different levels of medical training and experience. Three cohorts of subjects, second- and fourth- (final) year medical students and a group of general practitioners, completed a set of clinical reasoning problems. The responses of those whose scores fell below the 25th centile were analysed to establish the stage of the clinical reasoning process - identification of relevant information, interpretation or hypothesis generation - at which most errors occurred and whether this was dependent on problem difficulty and level of medical experience. Results indicate that hypothesis errors decrease as expertise increases but that identification and interpretation errors increase. This may be due to inappropriate use of pattern recognition or to failure of the knowledge base. Furthermore, although hypothesis errors increased in line with problem difficulty, identification and interpretation errors decreased. A possible explanation is that as problem difficulty increases, subjects at all levels of expertise are less able to differentiate between relevant and irrelevant clinical features and so give equal consideration to all information contained within a case. It is concluded that the development of clinical reasoning in medical students throughout the course of their pre-clinical and clinical education may be enhanced by both an analysis of the clinical reasoning process and a specific focus on each of the stages at which errors commonly occur.

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28 citations in Web of Science®

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ID Code: 95199
Item Type: Journal Article
Refereed: Yes
Keywords: analytical error, article, clinical education, clinical feature, controlled study, data analysis, diagnostic error, experience, general practitioner, human, hypothesis, information processing, medical education, pattern recognition, thinking, Attitude of Health Personnel, Clinical Competence, Curriculum, Data Collection, Data Interpretation, Statistical, Decision Making, Decision Theory, Diagnosis, Differential, Diagnostic Errors, Education, Medical, Graduate, Education, Medical, Undergraduate, Health Knowledge, Attitudes, Practice, Humans, Logic, Logistic Models, Models, Psychological, Needs Assessment, Odds Ratio, Physicians, Family, Problem Solving, Problem-Based Learning, Queensland, Students, Medical
DOI: 10.1080/01421590310001605688
ISSN: 0142-159X
Divisions: Current > QUT Faculties and Divisions > Faculty of Health
Copyright Owner: Copyright 2003 Taylor & Francis
Deposited On: 29 Apr 2016 01:37
Last Modified: 29 Apr 2016 01:37

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