Knowledge restructuring in expertise development: Evidence from pathophysiological representations of clinical cases by students and physicians

The present study was conducted to investigate qualitative changes that occ ur in the structure of knowledge in acquiring medical expertise. Therefore, the representation of pathophysiological knowledge was compared in subject s at four different levels of expertise. Subjects studied four clinical cas es under three different time constraints, and provided a diagnosis and a p athophysiological explanation for the signs and symptoms in each case. Both diagnostic accuracy and quality of explanations increased with level of ex pertise. The explanations of experts, however, were less elaborate and less detailed than those of students. Constraining processing time affected the quality of explanations of advanced students, but not that of experts; con versely, the elaborateness and level of detail of explanations was affected in experts but not in students. The findings are explained by a network mo del integrating the two-world hypothesis in which biomedical and clinical k nowledge are organised as two worlds apart (Patel, Evans, & Groen, 1989a, b ) and the hypothesis of knowledge encapsulation in which biomedical knowled ge becomes encapsulated into clinical knowledge (Schmidt & Boshuizen, 1992) .