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Acad Med. 2005 Oct;80(10):945-9.

The role of biomedical knowledge in clinical reasoning: a lexical decision study.

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Higher Education Research Centre Rotterdam, Department of Psychology/Woudestein, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands.



To investigate the role of biomedical and diagnostic inferences in clinical reasoning of advanced medical students and experienced family physicians using a lexical decision task.


In 2002, 15 family physicians and 20 fourth-year medical students at Maastricht University medical school in The Netherlands were instructed to carefully study 60 short clinical texts consisting of signs and symptoms associated with a particular disease. Participants read the texts on a computer screen and responded using a computer keyboard. Each text was followed by a target item (i.e., biomedical item, diagnostic item, or a nonword). Participants had to decide as quickly and accurately as possible whether the presented target item was a word or a nonword. For both groups, mean response time and mean error rate for all levels of item type were analyzed.


Findings indicate that both physicians and medical students judged diagnostic target items faster and more accurately than biomedical target items. However, physicians were considerably faster than were students on judging biomedical and diagnostic target items.


These findings are largely in line with knowledge encapsulation in that biomedical knowledge still plays a prominent role in the physician's clinical reasoning.

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