Problem Solving Strategy and Diagnostic Performance at Three Expertise Levels: Does the Problem Solving Approach Matter?

Abstract

Objective: Saudi Arabia has expanded dramatically in the number of medical schools during the last 10 years. The objective of this study was to explore the knowledge structure, clinical problem solving approach, and diagnostic performance at three levels of expertise in the medical field. Methods: This study involved twenty three participants. Fifth year medical students, internal medicine residents, and practicing internists were the participating medical staff representing novice, intermediate, and expert levels, consecutively. The data source was a written think aloud protocol on diagnosing a case of hyponatremia. Result: Diagnostic performance for novices, intermediates, and experts was 0%, 80%, 83%, respectively. At the students’ level, 30% (2/6) had reduced knowledge in this clinical presentation. Seven out of ten residents demonstrated an abridged knowledge structure. From the seven internists, two expressed an abridged knowledge structure, three had a compiled/scheme knowledge structure, and two had scripted knowledge structures. Knowledge structure was statistically predictive of diagnostic success (β=0.70, p<0.001). Conclusions: This study provides some insight into the knowledge structure and problem solving strategies at various levels of expertise. Medical education planning in Saudi Arabia should focus on enhancing expertise development and recognize the importance of a broad medical knowledge domain while for making the learning objectives explicit for learners.