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Problem-solving strategies in psychiatry: differences between experts and novices in diagnostic accuracy and reasoning

Authors Gabriel A, Violato C

Received 21 September 2012

Accepted for publication 31 October 2012

Published 10 January 2013 Volume 2013:4 Pages 11—16

DOI https://doi.org/10.2147/AMEP.S38372

Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2


Adel Gabriel,1,2 Claudio Violato2

1Departments of Psychiatry, University of Calgary, Calgary; 2Medical Education, Community Health Sciences, University of Calgary Calgary, Canada

Background: The purpose of this study was to examine and compare diagnostic success and its relationship with the diagnostic reasoning process between novices and experts in psychiatry.
Methods: Nine volunteers, comprising five expert psychiatrists and four clinical clerks, completed a think-aloud protocol while attempting to make a DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) diagnosis of a selected case with both Axis I and Axis III diagnoses.
Results: Expert psychiatrists made significantly more successful diagnoses for both the primary psychiatric and medical diagnoses than clinical clerks. Expert psychiatrists also gave fewer differential options. Analyzing the think-aloud protocols, expert psychiatrists were much more organized, made fewer mistakes, and utilized significantly less time to access their knowledge than clinical clerks. Both novices and experts seemed to use the hypothetic-deductive and scheme-inductive approaches to diagnosis. However, experts utilized hypothetic-deductive approaches significantly more often than novices.
Conclusion: The hypothetic-deductive diagnostic strategy was utilized more than the scheme-inductive approach by both expert psychiatrists and clinical clerks. However, a specific relationship between diagnostic reasoning and diagnostic success could not be identified in this small pilot study. The author recommends a larger study that would include a detailed analysis of the think-aloud protocols.

Keywords: diagnostic reasoning, knowledge structure, psychiatric diagnosis, hypothetic-deductive, scheme-inductive

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