Competency 6. Make informed diagnostic and therapeutic decisions that result in optimal clinical judgment

Abstract

When considering the developmental progression of making informed diagnostic and therapeutic decisions that result in optimal clinical judgment, the role of previous clinical experience cannot be emphasized enough. 1 Schmidt H.G. Boshuizen H.P.A. On acquiring expertise in medicine. Educ Psychol Rev. 1993; 5: 205-221 Crossref Scopus (243) Google Scholar , 2 Patel V.L. Groen G.J. Patel Y.C. Cognitive aspects of clinical performance during patient workup: the role of medical expertise. Adv Heatlh Sci Educ. 1997; 2: 95-114 Crossref PubMed Scopus (30) Google Scholar , 3 Bordage G. Elaborated knowledge: a key to successful diagnostic thinking. Acad Med. 1994; 69: 883-885 Crossref PubMed Scopus (204) Google Scholar , 4 Bowen J.L. Educational strategies to promote clinical diagnostic reasoning. N Engl J Med. 2006; 355: 2217-2225 Crossref PubMed Scopus (539) Google Scholar , 5 Schmidt H.G. Rikers R.M.J.P. How expertise develops in medicine: knowledge encapsulation and illness script formation. Med Educ. 2007; 41: 1133-1139 PubMed Google Scholar , 6 Schmidt H.G. Norman G.R. Boshuizen H.P.A. A cognitive perspective on medical expertise: theory and implications. Acad Med. 1990; 65: 611-621 Crossref PubMed Scopus (889) Google Scholar , 7 Chang R.W. Bordage G. Connell K.J. The importance of early problem representation during case presentations. Acad Med. 1998; 73: S109-S111 Crossref PubMed Scopus (82) Google Scholar , 8 Bordage G. Prototypes and semantic qualifiers: from past to present. Med Educ. 2007; 41: 1117-1121 Crossref PubMed Scopus (56) Google Scholar , 9 Coderre S. Mandin H. Harasym P.H. Fick G.H. Diagnostic reasoning strategies and diagnostic success. Med Educ. 2003; 37: 695-703 Crossref PubMed Scopus (232) Google Scholar With increasing clinical experience, learners do not simply gain new knowledge in an additive manner. Rather, they reorganize existing knowledge in an elaborated way that allows them to become more efficient and effective in diagnosing and treating new patients who possess features similar to those of previous patients. 1 Schmidt H.G. Boshuizen H.P.A. On acquiring expertise in medicine. Educ Psychol Rev. 1993; 5: 205-221 Crossref Scopus (243) Google Scholar , 2 Patel V.L. Groen G.J. Patel Y.C. Cognitive aspects of clinical performance during patient workup: the role of medical expertise. Adv Heatlh Sci Educ. 1997; 2: 95-114 Crossref PubMed Scopus (30) Google Scholar , 3 Bordage G. Elaborated knowledge: a key to successful diagnostic thinking. Acad Med. 1994; 69: 883-885 Crossref PubMed Scopus (204) Google Scholar , 4 Bowen J.L. Educational strategies to promote clinical diagnostic reasoning. N Engl J Med. 2006; 355: 2217-2225 Crossref PubMed Scopus (539) Google Scholar This highly learner-specific knowledge is best gained through individual clinical experience, which is a necessary but not sufficient prerequisite for developmental advancement in making informed diagnostic and therapeutic decisions that result in optimal clinical judgment. As Kolb 10 Kolb D.A. Experiential Learning: Experience as the Source of Learning and Development. Prentice-Hall, Upper Saddle River, NJ1983 Google Scholar suggests in his experiential learning theory, this knowledge is strengthened through reflective observation, active experimentation (eg, in a simulation environment), and abstract conceptualization. In fact, the mental energy that is saved as one becomes more efficient and effective in diagnosing and treating new patients must be reinvested in reflection and new learning if one is ultimately to become an expert clinician and not just an experienced nonexpert. 11 Bereiter C. Scardemalia M. Surpassing Ourselves: An Inquiry Into the Nature and Implications of Expertise. Open Court, Chicago, Ill1993 Google Scholar