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Medical Decision Making
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Diagnostic Reasoning of High - and Low - domain-knowledge Clinicians

A Reanalysis

Arthur S. Elstein, PhD

Benjamin Kleinmuntz, PhD

Mitchell Rabinowitz, PhD

Robert McAuley, MEd

James Murakami, MA

Paul S. Heckerling, MD

James M. Dod, PhD

Thinking-aloud protocols provided by Joseph and Patel were reanalyzed to determine the extent to which their conclusions could be replicated by independently developed coding schemes. The data set consisted of protocols from four cardiologists (low domain knowledge = LDK) and four endocrinologists (high domain knowledge = HDK), individually working on a diagnostic problem in endocrinology. The two analyses agree that the HDK physicians related data to potential diagnoses more than did the LDK group and were more focused on the correct diagnostic components. However, the reanalysis found no meaningful differ ence between the groups in diagnostic accuracy, speed of diagnosis, or the breadth of the search space used to seek a solution. In the reanalysis, the HDK physicians employed more single-cue inference and less multiple-cue inference. The generalizability of results of pro tocol-analysis studies can be assessed by using several complementary coding schemes. Key words: domain knowledge; protocol analysis; cognition; reasoning; diagnostic process. (Med Decis Making 1993;13:21-29)

Medical Decision Making, Vol. 13, No. 1, 21-29 (1993)
DOI: 10.1177/0272989X9301300104
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