Extract the Knowledge Structure of Medical Problem Solving: Learning from Cognitive Science

10.6145/jme.201112_15(4).0001

Der-Fang Chen；Tsuen-Chiuan Tsai

expertise system ； expertise extraction technique ； medical problem solving ； medical reasoning ； medical diagnosis ； medical cognition

Journal of Medical Education

15卷4期（2011 / 12 / 01）

323 - 331

英文

Medical diagnosis is a central component of medical competency, while being considered a challenge for young physicians. Teaching the ways that medical experts solve clinical problems will enhance students' learning gains. However, medical problems are often dealt differently across cases, physicians, and expertise levels. In order to extract expertise from experts, this study is to review and summarize the techniques for expertise extraction in the field of cognitive science, and explored the relevancy for studying medical problem-solving. Methods: The literature and books on ”extracting expertise” in medicine or in other fields are retrieved. The expertise extraction techniques included those being used in identifying knowledge components/facts, in establishing relationship between stored medical knowledge and in making inferences. Results: There are several extraction techniques being validated and reliable for use. The techniques are generally divided into two categories, direct and indirect. The direct methods that are considered applicable are: interview, questionnaire, observation of task performance, protocol analysis, and interruption analysis. The indirect techniques appropriate for uses are: hierarchal clustering, general weighted networks, ordered trees from recall, and repertory grid analysis. Conclusion: The extraction techniques in cognitive science are valid in understanding expertise in medical problem-solving. The choice of the tools should be dependent on the information, the purpose and the environment. With the use of experts' thoughts, teaching and learning in medical problem-solving will be greatly enhanced.

1. Janet EB: Knowledge Elicitation Tool Classification. Available at: [http://web.cs.wpi.edu/Research/aidg/KE-Rpt98.html] Accessed on 11 Sep, 2011.
2. Bordage, G.(1994).Elaborated knowledge: a key to successful diagnostic thinking.Acad Med,69,883-5.
3. Bordage, G.,Lemieux, M.(1991).Cognitive structures of experts and novices: semantic structures and diagnostic thinking of experts and novices.Acad Med,66,70-2.
4. Cantor, N.,Smith, E.,French, R.(1980).Psychiatric diagnosis as prototype categorization.J Abnorm Psychol,89,181-8.
5. Charlin, B,Tardif, J,Boshuizen, H.P.(2000).Scripts and medical diagnostic knowledge: theory and applications for clinical reasoning instruction and research.Acad Med,75(2),182-90.
6. Elstein, A.S.,Schwarz, A.(2002).Clinical problem solving and diagnostic decision making: selective review of the cognitive literature.BMJ,324(7339),729-32.
7. Gilhooly, KJ(1990).Cognitive psychology and medical diagnosis.Appl Cognitive Psychol,4,261-72.
8. Granovetter, M(1973).The strength of weak ties.Am J Sociol,78(6),1360-80.
9. Mandin, H.,Jones, A.,Woloschuk, W.(1997).Helping students learn to think like experts when solving clinical problems.Acad Med,72,173-9.
10. McLaughlin, K.,Mandin, H.(2002).Using "concept sorting" to study learning processes and outcomes.Acad Med,77,813-6.
11. Norman, G.(2005).Research in clinical reasoning: past history and current trends.Med Educ,39(4),418-27.
12. Novak, K,Mandin, H,Wilcox, E(2006).Using a conceptual framework during learning attenuates the loss of expert-type knowledge structure.BMC Med Educ,6,37.
13. Olsen, J.R.,Rueter, H.H.(1987).Extracting expertise from experts: methods for knowledge acquisition.Expert Systems,4(3),152-68.
14. Orman, G.(2005).Research in clinical reasoning: past history and current trends.Med Educ,39(4),418-27.
15. Sherbino, J.,Dore, K.L.,Siu, E.(2011).The effectiveness of cognitive forcing strategies to decrease diagnostic error: an exploratory study.Teach Learn Med,23(1),78-84.
16. Tsai, T.C.,Peter, H.H.,Sylvain, C.(2009).Assessing ethical problem solving by reasoning rather than decision making.Med Edu,43,1188-97.
17. Turnbull, J,Carbotte, R,Hanna, E(2000).Cognitive difficulty in physicians.Acad Med,75(2),177-81.
18. van Someren, M.W.,Barnard, Y.F.,Sandberg, J.A.C.(1994).The think aloud method: a practical guide to modeling cognitive processes.London:Academic Press.
19. West, C.K.(ed.),Farmer, J.A.(ed.),Wolff, P.M.(ed.)(1991).Instructional Design. Implications from Cognitive Science.New Jersey:Prentice Hall College Div.