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Diagnostic reasoning: where we've been, where we're going
Sandra M Monteiro1, Geoffrey Norman
1a Department of Psychology , Neuroscience & Behaviour, McMaster University , Hamilton , Ontario , Canada.
Teaching and Learning in Medicine
|November 20, 2013
Summary
Clinical diagnostic reasoning involves fast (System 1) and slow (System 2) processing. Current evidence suggests focusing on knowledge application, not just bias awareness or analytical thinking, improves diagnostic accuracy.
Area of Science:
- Cognitive Psychology
- Medical Education
- Clinical Decision Making
Background:
- Clinical diagnostic reasoning is often explained by dual-processing models, positing fast, unconscious (System 1) and slow, analytical (System 2) components.
- Variations in these models can lead to conflicting claims regarding diagnostic accuracy and error reduction strategies.
- This review critically examines theories and evidence supporting dual-processing models in clinical reasoning.
Purpose of the Study:
- To critically review current theories and evidence on clinical diagnostic reasoning, focusing on dual-processing models.
- To evaluate the effectiveness of strategies aimed at reducing diagnostic errors.
- To identify knowledge gaps and suggest future research directions in clinical reasoning.
Main Methods:
- Literature review of clinical reasoning research, with a specific focus on dual-processing theories.
- Analysis of evidence supporting or refuting the default/interventionist dual-processing model.
- Synthesis of findings related to error reduction strategies in medical diagnosis.
Main Results:
- Dual-processing models, particularly the default/interventionist model, are prevalent but face scrutiny.
- Strategies to increase analytical (System 2) processing or awareness of cognitive biases show limited impact on diagnostic error rates.
- Conversely, enhancing the application of relevant knowledge appears more successful in improving diagnostic performance.
Conclusions:
- Current dual-processing models may oversimplify clinical reasoning by focusing on processing strategy rather than knowledge retrieval.
- Relying solely on System 2 or bias awareness is insufficient for error reduction.
- Future research should explore how to effectively integrate and apply relevant knowledge in clinical diagnostic reasoning.
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