Content analysis of diagnostic thinking among expert and novice clinicians

Objectives: To ascertain whether the range and frequency of use of diagnostic thinking processes (DTP) (Gale & Marsden 1983) and the pieces of information involved in restorative treatment planning were different between novice and expert clinicians evaluating a standardized clinical case.

Methods: We video- and audio-recorded the interaction between clinicians and a standardized patient in a dental office. Each clinician was subsequently interviewed to stimulate his/her recall of cognitive strategies in a semi-structured interview. The recordings and case materials were separately evaluated using content-analysis to identify the diagnostic strategies and concepts used during the clinical consultation.

Results: Stability coefficients (Scott's pi) ranged from 0.63-0.71. Fifteen dentists (33% female) and 17 senior dental students (47% female) participated in consultations lasting (mean) 32.0 minutes (sd 12.9) among experts, and 29.9±7.1 among novices (range=13-52 minutes); actual contact time with patient was 26.4±13.9 minutes for experts, and 22.2±7.5 for novices (range 9-52). The time elapsed between the first and the last instances of the clinician looking in the mouth was similar between experts and novices (10.8±6.4 and 13.2±5.1 minutes; range=2-26). The main differences in DTP utilization concerned dentists conducting diagnostic interpretations of clinical findings with sufficient certainty to be considered definitive (DTP2) twice as often as students, who frequently resorted to engaging in mere pre-diagnostic interpretations (DTP1). Students also resorted more often to further general or clarifying enquiry in their search for information (DTP3). Fifteen families of concepts comprised 98 pieces of information used in conjunction with DTPs; differences in their use across experts and novices were rather small.

Conclusion: Identification of DTPs and concepts used by experts and novices suggested key differences in how they use information while gathering, determining, and negotiating the diagnostic process, thus offering opportunities for enhancing educational interventions to improve diagnostic decision-making skills. Funded by a present from the ADA Foundation.