The intermediate effect in clinical case recall is present in musculoskeletal physiotherapy

Abstract

Previous research into medical expertise has shown that expert physicians perform significantly better than non-experts when providing a diagnosis for a clinical case. By contrast, when asked to recall the details of the case, individuals of intermediate level of expertise (typically, final-year students) obtain better results than novices and experienced physicians, a phenomenon called the “intermediate effect”. However, this effect has not been documented outside of internal medicine and dentistry. The aim of this paper was to investigate the possibility that the intermediate effect in clinical case recall exists in musculoskeletal physiotherapy. 40 participants (sport science students, musculoskeletal physiotherapy students and expert musculoskeletal physiotherapists) were assigned to four groups based upon their experience in musculoskeletal physiotherapy (control group with no experience, novices, intermediates and experts). Participants were instructed to read a case study, provide a diagnosis, justify this diagnosis, and recall the case study. It was found that the quality of diagnosis and the number of high-level inferences increased with expertise. By contrast, recall performance followed an inverted U-curve, with the best recall being obtained by intermediates. Thus, the intermediate effect is present in musculoskeletal physiotherapy, despite clear differences in the way medicine and musculoskeletal physiotherapy are taught.