Some phenomena of medical students' diagnostic problem-solving

This paper introduces a perspective on medical problem-solving that derives from recent studies of content-related learning. Results from a study of fourth-year medical students' approaches to understanding a data base of significant facts about a patient (a problem synthesis) are presented. By analysing data collected in interviews, we obtain categories of description that portray the qualitatively different ways in which the information in diagnostic problems is handled by these students. Two major categories describe the variability in approach: 'ordering' and 'structuring'. The latter category contains elements that most clinical teachers would regard as desirable; the former represents a less satisfactory approach. We provisionally identify two diagnostic strategies within each of these categories. The perspective has implications for improving instruction and assessment.