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Related Experiment Video

Updated: May 29, 2026

Problem-Solving Before Instruction (PS-I): A Protocol for Assessment and Intervention in Students with Different Abilities
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Teaching posttraining: influencing diagnostic strategy with instructions at test.

Chan Kulatunga-Moruzi1, Lee R Brooks, Geoffrey R Norman

  • 1Faculty of Health Sciences, McMaster University, Michael G. DeGroote Centre for Learning and Discovery, room 2209, Hamilton ON, L8N 3Z5 Canada. kulatuc@mcmaster.ca

Journal of Experimental Psychology. Applied
|September 28, 2011
PubMed
Summary

Medical students

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Area of Science:

  • Medical Education
  • Cognitive Psychology
  • Diagnostic Reasoning

Background:

  • Medical diagnosis integrates analytic and similarity-based cognitive processes.
  • Debate exists on the primary process defining diagnostic expertise and optimal teaching methods.
  • Reducing diagnostic errors is a key challenge in clinical education.

Purpose of the Study:

  • To investigate the utilization of analytic and similarity-based diagnostic strategies in medical students.
  • To determine if post-training instructions can modify strategy balance and improve diagnostic accuracy.
  • To explore the coordination of these processes in clinical diagnosis.

Main Methods:

  • Two studies were conducted using medical students as participants.
  • Analytic processing was indexed by the typicality effect (accuracy on typical vs. atypical cases).
  • Similarity-based processing was indexed by the similarity effect (accuracy on similar vs. dissimilar cases).
  • Differential instructions were administered at the point of diagnosis to influence strategy use.

Main Results:

  • Participants using analytic strategies showed a larger typicality effect; those using similarity-based strategies showed a larger similarity effect.
  • Uninstructed students predominantly used analytic processing.
  • Dual instructions (similarity-based followed by analytic rules) improved overall diagnostic accuracy.
  • Prioritizing rule-based assessment may hinder subsequent similarity-based reasoning.

Conclusions:

  • Medical diagnosis effectively coordinates analytic and similarity-based processing.
  • Targeted instructions at the time of diagnosis can shift cognitive strategy balance.
  • Pedagogical interventions can enhance diagnostic accuracy and expertise in medical students.