Hypothesis Generation and the Coordination of Theory and Evidence in Novice Diagnostic Reasoning

Abstract

This study investigates hypothesis generation and evaluation in clinical problem solving by medical trainees. The study focuses on 1) directionality of reasoning and 2) use of confir mation and disconfirmation strategies in generating and evaluating hypotheses. Two clinical problems were divided into segments of information containing presenting complaint, past history, and physical examination. The initial information indicated a typical myocardial infarct but subsequent information contradicted it. The results showed that the participating students predominantly used forward reasoning and confirmation strategies. When faced with con tradictory evidence: 1) second-year students ignored cues in the problem or reinterpreted them to fit the hypothesis; 2) third-year students generated concurrent hypotheses to account for different sets of data; and 3) fourth-year students generated several initial hypotheses and subsequently narrowed the hypothesis space by generating a single coherent diagnostic explanation. The results are discussed in terms of coordination of clinical evidence and its relationship to scientific reasoning. Key words: hypothesis generation; diagnostic reasoning; novice strategies; medical problem solving. (Med Decis Making 1993;13:198-211)

Get full access to this article

View all access options for this article.

References

Feinstein AR Clinical Judgement. Baltimore: Wilkins and Williams, 1967.

Larkin JH , McDermott J. , Simon DP , Simon, HA. Expert and novice performance in solving physics problems. Science. 1980;208:1335-42.

Patel VL , Groen GJ Knowledge-based solution strategies in medical reasoning. Cogn Sci. 1986;10:91-116.

Voss JF Problem solving and the educational process. In Glaser R , Lesgold A , eds. Handbook of Psychology and Education. Hillsdale, NJ: Lawrence Erlbaum, 1989.

Patel VL , Groen GJ , Norman GR Reasoning and instruction in medical curricula. Cogn Instruct. 1993;10.

Braccio A. On-line analysis of novice problem solving on medicine. Unpublished MA thesis. McGill University, Montreal, Quebec, Canada, 1988.

Langley P. , Simon H. , Bradshaw GL , Zytkow JM Scientific discovery: computational explorations of the creative process. Cambridge, MA: MIT Press, 1987.

Dunbar K. Scientific reasoning strategies in a simulated molecular genetics environment . Proc 11th Annual Conf Cognitive Sciences Society . Hillsdale, NJ: Lawrence Erlbaum , 1989.

Dunbar K. , Schunn CD The temporal nature of scientific discovery : The roles of priming and analogy . Proc 12th Annual Conf Cognitive Sciences Society . Hillsdale, NJ: Lawrence Erlbaum , 1990.

10.

Klahr D. , Dunbar K. Dual space search during scientific reasoning. Cogn Sci. 1988;12:1-55.

11.

Kuhn D. Children and adults as intuitive scientists. Psychol Rev. 1989;96:674-89.

12.

Tweeney RD , Hoffner CE Understanding the microstructure of science: an example. Proc 9th Annual Conf Cognitive Sciences Society. Hillsdale, NJ: Lawrence Erlbaum, 1987.

13.

Popper KR Conjectures and Refutations. New York: Basic Books, 1963.

14.

Wason P. , Johnson-Laird PN Psychology of Reasoning. Cambridge, MA: Harvard University Press, 1972.

15.

Freedman EG Scientific induction: effects of test strategy and multiple hypothesis. Paper presented at the 32nd Annual Meeting of the Psychonomic Society, November 1991, San Francisco, CA .

16.

Nilsson NJ Principles of Artificial Intelligence. Palo Alto, CA: Tioga, 1980.

17.

Joseph G-M. , Patel VL Domain knowledge and hypothesis generation in diagnostic reasoning. Med Dec Making. 1990 ;10:31-46.

18.

Harrison TR Principles of Internal Medicine. 12th ed. New York: McGraw-Hill, 1991.

19.

Patel VL , Groen GJ , Arocha JF Medical expertise as a function of task difficulty. Mem Cogn. 1990;18:394-406.