EVALUATING EVIDENCE AGAINST DIAGNOSTIC HYPOTHESES IN CLINICAL DECISION-MAKING BY STUDENTS, RESIDENTS AND PHYSICIANS

Clinicians are faced with the difficulty of filtering large quantities of information and incorporating evidence to make safe and accurate d iagnostic, therapeutic and management decisions. One solution to this difficulty is the development of evidence-based decision support tools designed to provide relevant and up-to-date evidence to clinicians. H owever, as investigations of medical decision making have found that h ypothesis generation and clinical reasoning differ as a function of ex pertise, the gathering, interpretation and use of evidence against hyp otheses depends on the prior knowledge of the clinician. The specific focus of the study is to understand how clinical evidence is gathered and evaluated during diagnostic reasoning. Verbal data during clinical interactions with physicians, residents and final year medical studen ts were collected and transcribed. The dialogues were analyzed using t hree levels of coding: cognitive, epistemological and linguistic-pragm atic perspectives. Results show that: (a) the ability to index and use adequate evidence by physicians, residents and students is a function of the early generation of accurate hypotheses; and (b) strategies fo r resolving inconsistent evidence differ as a function of medical expe rtise. The relationship between these findings and its application for the development of adequate knowledge-based systems for indexing and retrieval is discussed. (C) 1998 Elsevier Science Ireland Ltd. All rig hts reserved.