Diagnostic Competence Research Articles

Development and Changes in Student Teachers´ Knowledge Concerning Diagnostic in Chemistry Teaching - A Longitudinal Case Study

A knowledge about pedagogical diagnosis is important for professional teachers for teaching heterogeneous chemistry classes. For chemistry teachers, the knowledge about their students` perceptions, attitudes, knowledge, previous experience or their interest is crucial for planning lessons. Therefore, the diagnosis is a key component of teachers` knowledge. However, research in this area is still underrepresented. It is clear, that the development of teachers` knowledge about diagnosis in chemistry teaching and learning should be started during the university teacher education program. But, how does this knowledge develop or change during the teacher training program in chemistry education? This paper attempts to investigate this development with a longitudinal interview case study. Two chemistry student teachers participated the study and were interviewed at seven different time points during their teacher education program. The interview and the analysis are based on the definition by Jager with a focus on the four dimensions of the diagnostic competence: i. Competence Knowledge, ii. Conditional Knowledge, iii. Technological Knowledge and iv. Knowledge of Change. The analysis of the interviews follows documentary method. The results show a different development of student teachers, which allowed a contrasting view of the students. From this, implications for the teacher training will be presented.

Factors that influence Canadian internal medicine residents' choice to pursue a rheumatology career.

In Canada, little is known about residents' self-confidence to diagnose/treat musculoskeletal (MSK) disease and factors affecting pursuit of a rheumatology career. Our study explored these factors. An online survey (descriptive cross-sectional design) was distributed to Canadian postgraduate year (PGY) 1 and 2 internal medicine (IM) residents. Questions probed self-confidence in rheumatology and factors influencing subspecialty career choice. Frequencies were determined and responses compared between PGY-1 and PGY-2 using univariate statistical analyses. Fifty-four IM residents completed the survey. PGY-2 residents were statistically more certain in subspecialty decidedness and had higher levels of self-confidence to diagnose/treat MSK disease and perform a physical exam. "Quality of life" was the most encouraging factor for a rheumatology career choice followed by "job opportunities" and "previous clinical exposure." Although 50% of PGY-1 residents had completed a rheumatology clinical rotation, 76% indicated that increased knowledge would affect rheumatology career choice. Only 38% were interested in novel rheumatology education. No difference in rheumatology exposure, rheumatology clinical rotation completion year, or rheumatology career choice was observed. Our research confirms findings from similar United States (US) and United Kingdom (UK) studies that suggest that increased MSK knowledge positively influences residents' confidence to diagnose/treat MSK disease. Our study differs with Canadian PGY-1 and PGY-2 IM residents by evaluating self-confidence to diagnose/treat MSK disease separately from self-confidence to perform a physical exam. Significant differences between first and second year trainees suggest types/quality of rheumatology experiences (e.g., case complexity, diagnostic problem-solving competency) may affect self-confidence to diagnose/treat MSK disease factors and rheumatology career choice.

Teachers' Diagnostic Competence in the Context of Gender- and Migration- Related Stereotyping

Teachers' Diagnostic Competence in the Context of Gender- and Migration- Related Stereotyping

Getting the picture: visual interpretation in ophthalmology residency training.

Visual interpretation is essential in many fields of health care. Although diagnostic competency can be measured as an educational outcome, few accounts have addressed tacit aspects of visual interpretation in clinical training; these include the disciplining of the trainee's attentions and the trainee's acculturation into expected styles of communicating visual interpretations to others. This paper describes values and dispositions that are taught to ophthalmology trainees as they learn to reason through visual information, and explores how these qualities are evaluated during residency training. The project was based on 6 months of ethnographic participant observation and interviews in an ophthalmology residency programme. Observational notes and interview transcripts pertaining to visual interpretation were isolated for qualitative analysis in the tradition of sociocultural anthropology, guided by literature on communication in medical education and the socialisation of health professionals. Residents and faculty members identified visual interpretation as one of the most challenging skills expected of ophthalmology trainees. They expressed a belief that 'systematic' approaches, where visual information is parsed in a stepwise fashion, reduce the chance of trainees overlooking or misinterpreting key diagnostic features. This sensory discipline was represented in narrative form when faculty members asked residents to interpret images aloud, as residents were expected to follow prescribed sequences for describing the content of images before commenting on possible diagnoses. Sensory processing is ordinarily opaque to outside observers, but the ritual of describing images in highly regimented narratives allows residents to demonstrate how they gather and reason through visual information. The form of these narratives reflects values that residents are expected to embody during their training, such as being thorough and methodical; it may also serve a pedagogical function by entrenching those values. Further research is needed to characterise how the performance of speech genres shapes the interpretive skills of medical trainees.

Evaluation of malaria rapid diagnostic test (RDT) use by community health workers: a longitudinal study in western Kenya

BackgroundMalaria rapid diagnostic tests (RDTs) are a simple, point-of-care technology that can improve the diagnosis and subsequent treatment of malaria. They are an increasingly common diagnostic tool, but concerns remain about their use by community health workers (CHWs). These concerns regard the long-term trends relating to infection prevention measures, the interpretation of test results and adherence to treatment protocols. This study assessed whether CHWs maintained their competency at conducting RDTs over a 12-month timeframe, and if this competency varied with specific CHW characteristics.MethodsFrom June to September, 2015, CHWs (n = 271) were trained to conduct RDTs using a 3-day validated curriculum and a baseline assessment was completed. Between June and August, 2016, CHWs (n = 105) were randomly selected and recruited for follow-up assessments using a 20-step checklist that classified steps as relating to safety, accuracy, and treatment; 103 CHWs participated in follow-up assessments. Poisson regressions were used to test for associations between error count data at follow-up and Poisson regression models fit using generalized estimating equations were used to compare data across time-points.ResultsAt both baseline and follow-up observations, at least 80% of CHWs correctly completed 17 of the 20 steps. CHWs being 50 years of age or older was associated with increased total errors and safety errors at baseline and follow-up. At follow-up, prior experience conducting RDTs was associated with fewer errors. Performance, as it related to the correct completion of all checklist steps and safety steps, did not decline over the 12 months and performance of accuracy steps improved (mean error ratio: 0.51; 95% CI 0.40–0.63). Visual interpretation of RDT results yielded a CHW sensitivity of 92.0% and a specificity of 97.3% when compared to interpretation by the research team. None of the characteristics investigated was found to be significantly associated with RDT interpretation.ConclusionsWith training, most CHWs performing RDTs maintain diagnostic testing competency over at least 12 months. CHWs generally perform RDTs safely and accurately interpret results. Younger age and prior experiences with RDTs were associated with better testing performance. Future research should investigate the mode by which CHW characteristics impact RDT procedures.

Development of a competency model for real-estate project managers: case study of China

ABSTRACTCurrently, the enterprises have been paying more attention to talent and high quality has increasingly become a valuable resource for them. For the real-estate industry, excellent project managers are an important guarantee for project success. Their competencies affect project schedules to a large extent. Through data collection, analysis, and verification, and using the behavioural event interview method, this study determines the competencies of real-estate project managers and preliminarily establishes a competency model for real-estate project managers. The model includes both diagnostic competency and basic competency in which the former includes professional spirit, structured thinking, control ability, holistic view, and communication management, while the latter includes team spirit and experience. Our research results have application prospects in identifying the competencies of real-estate project managers and can help the enterprises quickly identify excellent talent, define the talent cultivation focus and direction, and establish a talent pool, so as to provide human resources and guarantee smooth implementation of projects.

Self-Formation Assessed by Cumulative Summation Test Does Not Reach Recommended Thresholds for Optical Diagnosis of Colorectal Polyps ≤ 7mm.

Accurate optical diagnosis of diminutive polyps would allow implementing a resect and discard strategy. We evaluated the learning curve of a single training session followed by self-education in subjects with no endoscopic experience. Learning curves were evaluated in 38 subjects employing learning curve-cumulative summation (LC-CUSUM) tests, with each participant attending one training session regarding narrow band imaging and optical diagnosis and then individually assessing 100 lesions, receiving feedback after each diagnosis. Diagnostic accuracy was subsequently evaluated in 180 patients with lesions ≤ 7mm. Evaluators predicted each polyp's histology and recommended a surveillance interval. Determinants of accuracy were explored using regression analysis. According to the LC-CUSUM curve, 20 evaluators (52.6%) reached diagnostic competence after 57 lesions (IQR 55-76.5). During the diagnostic performance assessment, 11,666 diagnoses and 6840 follow-up recommendations were generated. Considering high confidence diagnoses, accuracy was 81.3% (80.5-82.1%), negative predictive value (NPV) for rectosigmoid adenomas 78.6% (76.4-80.6%), and sensitivity for adenomas 86.6% (85.8-87.4%). Two (5.3%) evaluators reached a ≥ 90% accuracy, 3 (7.9%) presented a NPV for rectosigmoid adenomas ≥ 90%, and 18 (47.4%) a sensitivity for adenomas ≥ 90%. Multivariable logistic regression showed high confidence and size ≥ 5mm as the strongest predictors of accuracy. Fifteen (39.5%) evaluators recommended a correct or reduced follow-up interval in over 90% of subjects. Self-formation after a single training session did not allow most evaluators to reach the required accuracy. LC-CUSUM tests did not identify competent evaluators. Despite these results, 86.7% of follow-up intervals would have been corrected or reduced.

Development of an instrument and evaluation patter for for the analyisis of chemistry student teachers` diagnostic competence

Diagnostics have become one of the central tools for planning teaching which accommodates learners' needs. Changes occurring in the chemistry classroom caused by rising levels of student heterogeneity play a crucial role. Thus, diagnostic processes are seen to be part of the cure. For this reason, chemistry (student) teachers need to understand the possibilities and potential for diagnostics in their classrooms. The present study employs a definition of diagnostic competence by Jager. He emphasizes three domains: conditional knowledge, technological knowledge and knowledge of change. To achieve such competences, student teachers need to start learning about it during their university training. Since there are only few and mainly quantitative instruments in this field, the present paper describes the development of an instrument and an evaluation pattern for analyzing student teachers` diagnostic competence in chemistry. The instrument is a qualitative approach. It is based upon a written essay and open-ended questions. The evaluation pattern will be in focus. Initial results from the present study will also be discussed.

When students doubt their teachers’ diagnostic competence: Moderation in the internal/external frame of reference model.

The internal/external frame of reference model (I/E model) posits that individuals’ achievement-related self-concepts are formed through social comparisons (e.g., self vs. peers) within academic domains and dimensional comparisons (e.g., math vs. verbal) between distinct domains. A large body of research has supported the theorized pattern of positive within-domain and negative cross-domain effects of achievement on self-concept. However, research on moderators of these effects has been scarce. In this article, we report results from 2 samples of 7th graders (Nsample1 = 1,045 and Nsample2 = 1,966) in which we investigated whether students’ perceptions of teachers’ domain-specific competence in judging students’ achievement moderated the relation between teacher-assigned grades and students’ self-concepts in the I/E model. Structural equation modeling was used to estimate the I/E model, which also included teachers’ perceived diagnostic competence in each domain (i.e., math and verbal) and 4 latent interaction variables derived from that competence and from school grades in both domains. Both studies found support for the predictions of the I/E model. The cross-domain effect on math self-concept was consistently moderated in both studies: The lower students perceived their teachers’ competence in diagnosing math achievement, the stronger the negative path from verbal grade to math self-concept. Furthermore, the results tentatively imply that the positive within-domain effect of verbal grade on verbal self-concept is stronger when students’ perceptions of teachers’ diagnostic competence in judging verbal achievement are higher. The results extend knowledge on the conditions of academic self-concept formation and provide valuable insights into possible ramifications of teachers’ judgment accuracy. (PsycINFO Database Record (c) 2018 APA, all rights reserved)

Preventing "Neurophobia": Remodeling Neurology Education for 21st-Century Medical Students through Effective Pedagogical Strategies for "Neurophilia".

Neurology has a reputation, particularly as a complex “head-to-toe” discipline for undergraduate medical students. Neurophobia syndrome, a global phenomenon, fundamentally stems from pedagogical deficiencies during the undergraduate curriculum, the lack of vertical integration between basic neurosciences and clinical bedside neurology, the lack of clinical reasoning exercises, cognitive heuristics, and clinical problem-solving, errors in diagnostic competence, and hyposkilia. This ultimately results in poor clinical competence and proficiency in clinical neurology and causes attrition in nurturing a passion for learning the neurology discipline. This article explores plausible factors that contribute to the genesis of neurophobia and multifaceted strategies to nurture interest in neurosciences and provide possible solutions to demystify neurology education, especially the need for evidence-based educational interventions. Remodeling neurology education through effective pedagogical strategies and remedial measures, and using the Miller's pyramid, would provide a framework for assessing clinical competence in clinical bedside neurology. Technology-enhanced education and digital classrooms would undoubtedly stamp out neurophobia in medical students of the 21st century. It will not frighten off another generation of nonneurologist physicians to empower them to hone expertise in order to tackle the increasing burden of neurological disorders in India. Furthermore, promoting neurophilia would facilitate the next generation of medical students in pursuing career options in neurology which would be quintessential not only in closing India's looming neurologist workforce gap but also in fostering interest in research imperatives in the next generation of medical students.

Core competencies in clinical neuropsychology training across the world

Objective: This work aimed to review main competency requirements from training models in countries with well-established specialties in clinical neuropsychology and to extract core competencies that likely will apply to clinical neuropsychologists regardless of regional and cultural context. Method: We reviewed standards for post-graduate training in clinical neuropsychology from countries in Europe, Australia, and North America based on existing literature, presentations at international conferences, and from description of the training models from national psychological or neuropsychological associations. Results: Despite differences, the reviewed models share similar core competencies considered necessary for a specialty in clinical neuropsychology: (1) In-depth knowledge of general psychology including clinical psychology (post-graduate level), ethical, and legal standards. (2) Expert knowledge about clinically relevant brain–behavioral relationships. (3) Comprehensive knowledge about, and skills in, related clinical disciplines. (4) In-depth knowledge about and skills in neuropsychological assessment, including decision-making and diagnostic competency according to current classification of diseases. (5) Competencies in the area of diversity and culture in relation to clinical neuropsychology. (6) Communication competency of neuropsychological findings and test results to relevant and diverse audiences. (7) Knowledge about and skills in psychological and neuropsychological intervention, including treatment and rehabilitation. Conclusions: All the models have undergone years of development in accordance with requirements of national health care systems in different parts of the world. Despite differences, the common core competency requirements across different regions of the world suggest generalizability of these competencies. We hope this summary can be useful as countries with less established neuropsychology training programs develop their models.

Exploring Chemistry Student Teachers’ Diagnostic Competence—A Qualitative Cross-Level Study

Diagnostic competence is an important skill of professional teachers and is a part of Pedagogical Content Knowledge (PCK). Because increasing heterogeneity and diversity characterize our schools, diagnostic competence plays a prominent role in teacher pre- and in-service courses. At our university, two modules are focused on examining student teachers’ diagnostic competence in chemistry. The present paper describes a cross-level case study analyzing three groups of student teachers in different phases of their university teacher training program. The study is based on a qualitative research study with a total of 108 participants. The results show both positive and negative developments in teacher trainees’ diagnostic competence. They show that attitudes and beliefs about heterogeneity can be changed from a rather negative viewpoint to a more positive one. The results will be presented and discussed below. Suggestions for further development will be given.

Knowledge and attitude of Malaysia’s Muslim faith healers in dealing with the mentally ill

ABSTRACTMuslim faith healers are often sought by the Malaysian public as an avenue to address psychological distress. “Ruqyah” refers to the recitation of verses from the Qur'an and/or sayings of Prophet Muhammad (PBUH) and is used by Muslim faith healers as a method of treatment. This study was conducted to assess the knowledge and attitude of Muslim faith healers in dealing with psychiatric patients in Malaysia. Seven Muslim faith healers were interviewed. The interviews were transcribed verbatim, and analysed qualitatively using thematic content analysis. The authors identified four themes: understanding of psychiatric illnesses, diagnostic competence, patients' referral, and integrating “ruqyah” into mainstream psychiatry. It was found that the respondents had limited knowledge of psychiatric illness, focusing on “ruqyah” as the main intervention in treating psychiatric illness. Recognizing the important role played by Muslim faith healers in the treatment of psychiatric illness in Malaysia, collaboration between them and fellow psychiatrists is deemed highly necessary.

Worked examples with errors: when self-explanation prompts hinder learning of teachers diagnostic competences on problem-based learning

To diagnose classroom situations is crucial for teachers’ everyday practice. The approach of worked examples with errors seems promising to support the diagnosis of classroom situations in student teachers (Stark et al. in Learn Instr 21(1):22–33, 2011). To enhance that approach, error-explanation prompts and an adaptable feedback method to help the learner realize why an error happened and how to prevent a recurrence might be beneficial. In this empirical study, we investigated whether error-explanation prompts and adaptable feedback can facilitate diagnostic competences. N = 108 student teachers took part in a 2 × 2 factorial design (with and without error-explanation prompts as well as with and without adaptable feedback). Error-explanation prompts had a positive effect on declarative-conceptual knowledge if combined with adaptable feedback. Student teachers might have realized a lack of basic concepts and focused their attention on the declarative-conceptual knowledge in the feedback. Contrary to our expectations, however, error-explanation prompts hindered rather than facilitated learning of practical diagnostic knowledge.

Misclassification of hypertrophic cardiomyopathy: validation of diagnostic codes.

PurposeTo validate diagnostic codes for hypertrophic cardiomyopathy (HCM), analyze misclassfications, and estimate the prevalence of HCM in an unselected Swedish regional cohort.Patients and methodsUsing the hospitals’ electronic medical records (used for the Swedish National Patient Register), we identified 136 patients from 2006 to 2016 with the HCM-related codes 142.1 and 142.2 (International Classification of Diseases).ResultsOf a total of 129 residents in the catchment area, 88 patients were correctly classified as HCM (positive predictive value 68.2%) and 41 patients (31.8%) were misclassified as HCM. Among the 88 HCM patients (52.2% males), 74 were alive and 14 were dead (15.9%). This yields an HCM prevalence of 74/183,337, that is, 4.0 diagnosed cases per 10,000 in the adult population aged ≥18 years. The underlying diagnoses of misclassified cases were mainly hypertension (31.7%) and aortic stenosis (22.0%). Other types of cardiomyopathies accounted for several cases of misclassification: dilated (nonischemic or ischemic), left ventricular noncompaction, and Takotsubo. Miscellaneous diagnoses were amyloidosis, pulmonary stenosis combined with ventricular septal defect, aortic insufficiency, athelete’s heart, and atrioventricular conduction abnormality. The mean age was not significantly different between HCM and misclassified patients (65.8±15.8 vs 70.1±13.4 years; P=0.177). There were 47.8% females among HCM and 60.8% females among misclassified (P=0.118).ConclusionOne-third of patients diagnosed as HCM are misclassified, so registry data should be interpreted with caution. A correct diagnosis is important for decision-making and implementation of optimal HCM care; efforts should be made to increase awareness of HCM and diagnostic competence throughout the health care system.

Deepening prospective mathematics teachers’ diagnostic judgments: Interplay of videos, focus questions, and didactic categories

This article combines different conceptualizations of teachers' diagnostic competence in listening to students' mathematical thinking processes on the levels of general perspectives, noticed aspects and activated didactic categories. An empirical study of 159 prospective mathematics teachers' diagnostic judgments investigated how these levels are related and how they can be enhanced by focus questions and an intervention introducing relevant categories. For this purpose, 2×159 written diagnostic judgments, before and after a short intervention, were compared with respect to general perspectives, activated categories and aspects noticed in the video. As a means of comparing, a coding scheme was developed with respect to a sound conceptualization of diagnostic competence and to interrater reliability. The comparison shows that video alone cannot enhance prospective teachers' capacities of noticing, hence the activation and reflection of didactic categories is crucial. Possible theoretical consequences for a multi-facetted conceptualization of diagnostic competence and practical consequences for teacher education courses are discussed.

Improving the judgment of task difficulties: prospective teachers’ diagnostic competence in the area of functions and graphs

To teach adaptively, teachers should be able to take the students’ level of knowledge into account. Therefore, a key component of pedagogical content knowledge (PCK) is the ability to assume the students’ perspectives. However, due to the so-called expert blind spot, teachers tend to misestimate their students’ knowledge, such as when estimating the difficulty of a given task. This empirically well-documented estimation bias is predicted by Nickerson’s anchoring and adjustment model, which generally explains how people take on other people’s perspectives. In this article, we present an intervention study that aims to improve the accuracy of prospective teachers’ judgments of task difficulty in the area of functional thinking. Two types of treatments are derived from Nickerson’s model. In the first condition (PCK group), participants acquire knowledge about task characteristics and students’ misconceptions. The second condition (sensitizing group) serves to control the idea that potential improvements in the PCK group are not merely based on a pure sensitization of the expert’s estimation bias. Accordingly, these participants are only informed about the general tendency of overestimating task difficulties. The results showed that the PCK group improved both in terms of the accuracy of the estimated solution rates and the accuracy of rank order, whereas the sensitizing group only improved in regard to the former. Thus, the study shows that prospective teachers’ diagnostic judgments can be improved by teaching them relevant PCK in a short amount of time.

Assessment of a Tele-education System to Enhance Retinopathy of Prematurity Training by International Ophthalmologists-in-Training in Mexico

To evaluate a tele-education system developed to improve diagnostic competency in retinopathy of prematurity (ROP) by ophthalmologists-in-training in Mexico. Prospective, randomized cohort study. Fifty-eight ophthalmology residents and fellows from a training program in Mexico consented to participate. Twenty-nine of 58 trainees (50%) were randomized to the educational intervention (pretest, ROP tutorial, ROP educational chapters, and posttest), and 29 of 58 trainees (50%) were randomized to a control group (pretest and posttest only). A secure web-based educational system was created using clinical cases (20 pretest, 20 posttest, and 25 training chapter-based) developed from a repository of over 2500 unique image sets of ROP. For each image set used, a reference standard ROP diagnosis was established by combining the clinical diagnosis by indirect ophthalmoscope examination and image-based diagnosis by multiple experts. Trainees were presented with image-based clinical cases of ROP during a pretest, posttest, and training chapters. The accuracy of ROP diagnosis (e.g., plus disease, zone, stage, category) was determined using sensitivity and specificity calculations from the pretest and posttest results of the educational intervention group versus control group. The unweighted kappa statistic was used to analyze the intragrader agreement for ROP diagnosis by the ophthalmologists-in-training during the pretest and posttest for both groups. Trainees completing the tele-education system had statistically significant improvements (P < 0.01) in the accuracy of ROP diagnosis for plus disease, zone, stage, category, and aggressive posterior ROP (AP-ROP). Compared with the control group, trainees who completed the ROP tele-education system performed better on the posttest for accurately diagnosing plus disease (67% vs. 48%; P= 0.04) and the presence of ROP (96% vs. 91%; P < 0.01). The specificity for diagnosing AP-ROP (94% vs. 78%; P < 0.01), type 2 ROP or worse (92% vs. 84%; P= 0.04), and ROP requiring treatment (89% vs. 79%; P < 0.01) was better for the trainees completing the tele-education system compared with the control group. Intragrader agreement improved for identification of plus disease, zone, stage, and category of ROP after completion of the educational intervention. A tele-education system for ROP education was effective in improving the diagnostic accuracy of ROP by ophthalmologists-in-training in Mexico. This system has the potential to increase competency in ROP diagnosis and management for ophthalmologists-in-training from middle-income nations.

Kompetencje diagnostyczne nauczyciela w kontekście pomocy psychologiczno-pedagogicznej w szkole

&lt;p&gt;Profesjonalizm przejawia się w posiadaniu określonych cech i wysokich kompetencji. Podejście takie odnosi się również do współczesnego nauczyciela. Profesjonalny nauczyciel to przede wszystkim kompetentny nauczyciel. W literaturze psychopedagogicznej określa się różne kompetencje, jakie powinien nabyć i rozwijać nauczyciel. W klasyfikacjach kompetencji nauczycielskich coraz częściej pojawia się też kompetencja diagnostyczna. To m.in. dzięki tej kompetencji nauczyciel w codziennej pracy dydaktyczno-wychowawczej może w porę dostrzec trudności i zdolności dziecka, rozpoznać jego indywidualne możliwości psychofizyczne oraz potrzeby rozwojowe i edukacyjne. Nauczycielska kompetencja diagnostyczna warunkuje optymalne i efektywne organizowanie pomocy psychologiczno-pedagogicznej w szkole. Właściwa diagnoza dokonana przez nauczycieli uczących dziecko pozwala im określić, w jaki sposób pracować z uczniem, aby ograniczyć lub wyeliminować trudności oraz zwiększyć jego motywację do pracy. Niniejszy artykuł dotyczy kompetencji diagnostycznych nauczyciela w kontekście pomocy psychologiczno-pedagogicznej udzielanej uczniowi w szkole.&lt;/p&gt;

Clinical reasoning and dual mental processing in diagnostic competence.

Clinical reasoning and dual mental processing in diagnostic competence.