The Contrast Between Expert And Novice On Clinical Reasoning In Medicine

The cultivation of clinical reasoning competence is the hinge on which a novice resident grows into an expert. Clinical reasoning competence that focuses on tasks consists of basic medical knowledge, clinical experience and diagnostic strategies. The improvement of diagnostic strategies is the indication of the advancement of the clinical reasoning. While the diagnostic strategies is the application of the basic medical knowledge and the clinical experience. We use the expert-novice study methods to probe into the medical reasoning competence and find,(1) Diagnosis is based on the representation of the case.(2) Representing the case is the process of building the situation model and it helps to generate hypotheses. The realization of the inconsistence of the situation model can bring forward new hypotheses.(3) The selection of the information embodies the effect of basic medical knowledge and clinical experience on the diagnostic strategies. The basic medical knowledge leads to the common preference on the selection, and the personal clinical experience leads to the tremendous individual difference.(4) The quality of the reasoning also embodies the effect of basic medical knowledge and clinical experience on the diagnostic strategies. The expert can integrate the information and receive a deep inference, while the novice only can get a superficial inference on single information. The expert can test the hypotheses from more aspects, and they can use some more remote but impelling evidences to do the inference.(5) Not only the automatization of the skills but also the change of the cognitive mode show the effect of the clinical experience on the diagnostic strategies. The accumulation of the clinical experience means a change from perceptual to cognitive processing.The apocalypse of above-mentioned findings is that: the cultivation of the clinical reasoning competence is closely related to the acquiring of basic medical knowledge and clinical experience. The basic medical knowledge and the clinical experience is necessary for shaping medical expertise.