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When should physicians use intuition versus reflection to make a clinical diagnosis?

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Hess BJ, Lipner RS. — American Board of Internal Medicine

Graber ML. — RTI International

Thompson V. — University of Saskatchewan

Presented: American Educational Research Association Annual Meeting, April 2013

Abstract: In two-thirds of all diagnostic errors, cognitive shortcomings can be identified, for example, relying on intuitive (speedy) reasoning instead of practicing reflection (deliberation) when making a diagnosis. Little is known about the contextual factors (e.g., case complexity, physicians’ expertise) that indicate which diagnostic reasoning process is more appropriate. Residents’ time to initial response and frequency of answer changes from 80 diagnosis questions on a high-stakes medical certification exam were used to demonstrate that, in general, reflective reasoning (slower speed, more answer changes) yielded more correct diagnoses. Implications for resident training and test development were discussed.

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