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The Role of Basic Science Knowledge and Clinical Knowledge in Diagnostic Reasoning: A Structural Equation Modeling Approach

de Bruin, Anique B. H. MSc; Schmidt, Henk G. PhD; Rikers, Remy M. J. P. PhD

Academic Medicine:
Research Report
Abstract

Purpose: To examine four theories on the role of basic science knowledge and clinical knowledge in diagnostic reasoning.

Method: In 2000–01, the authors tested the basic science and clinical knowledge and diagnostic performances of 59 family physicians and 184 second- to sixth-year medical students at Maastricht University, The Netherlands. Structural equation modeling was used to analyze the data. Four theoretical models were tested. In the first model only basic science knowledge is involved in diagnostic reasoning; in the second model only clinical knowledge is related to diagnostic reasoning; in the third model, clinical knowledge is related to diagnostic reasoning, but basic science knowledge is integrated in clinical knowledge; and in the fourth model, both basic science knowledge and clinical knowledge independently influence diagnostic reasoning.

Results: Forty-four (75%) of the family physicians and 184 (100%) of the students responded. The results indicated that the third model, which is based on the knowledge encapsulation theory, provided the best fit to the data, whereas the models that had directly related basic science knowledge with diagnostic performance did not fit the data adequately.

Conclusion: The results generally supported the third model by Schmidt and Boshuizen of knowledge encapsulation theory suggesting that basic science knowledge is activated in expert diagnostic reasoning through its relation with clinical knowledge.

Author Information

Ms. de Bruin is assistant professor, Department of Psychology, Erasmus University Rotterdam, The Netherlands.

Dr. Schmidt is professor, Department of Psychology, Erasmus University Rotterdam, The Netherlands.

Dr. Rikers is associate professor, Department of Psychology, Erasmus University Rotterdam, The Netherlands. At the time this study was conducted, all three authors were at Maastricht University, The Netherlands.

Correspondence should be addressed to Ms. de Bruin, Department of Psychology, WJ5-09, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands; e-mail: 〈debruin@fsw.eur.nl〉.

© 2005 Association of American Medical Colleges