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Diagnostic thinking and information used in clinical decision-making: a qualitative study of expert and student dental clinicians
BACKGROUND: It is uncertain whether the range and frequency of Diagnostic Thinking Processes (DTP) and pieces of information (concepts) involved in dental restorative treatment planning are different between students and expert clinicians. METHODS: We video-recorded dental visits with one standardiz...
Autores principales: | , , , , |
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Formato: | Texto |
Lenguaje: | English |
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BioMed Central
2010
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2879228/ https://www.ncbi.nlm.nih.gov/pubmed/20465826 http://dx.doi.org/10.1186/1472-6831-10-11 |
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author | Maupomé, Gerardo Schrader, Stuart Mannan, Saurabh Garetto, Lawrence Eggertsson, Hafsteinn |
author_facet | Maupomé, Gerardo Schrader, Stuart Mannan, Saurabh Garetto, Lawrence Eggertsson, Hafsteinn |
author_sort | Maupomé, Gerardo |
collection | PubMed |
description | BACKGROUND: It is uncertain whether the range and frequency of Diagnostic Thinking Processes (DTP) and pieces of information (concepts) involved in dental restorative treatment planning are different between students and expert clinicians. METHODS: We video-recorded dental visits with one standardized patient. Clinicians were subsequently interviewed and their cognitive strategies explored using guide questions; interviews were also recorded. Both visit and interview were content-analyzed, following the Gale and Marsden model for clinical decision-making. Limited tests used to contrast data were t, χ(2), and Fisher's. Scott's π was used to determine inter-coder reliability. RESULTS: Fifteen dentists and 17 senior dental students participated in visits lasting 32.0 minutes (± 12.9) among experts, and 29.9 ± 7.1 among students; contact time with patient was 26.4 ± 13.9 minutes (experts), and 22.2 ± 7.5 (students). The time elapsed between the first and the last instances of the clinician looking in the mouth was similar between experts and students. Ninety eight types of pieces of information were used in combinations with 12 DTPs. The main differences found in DTP utilization had dentists conducting diagnostic interpretations of findings with sufficient certainty to be considered definitive twice as often as students. Students resorted more often to more general or clarifying enquiry in their search for information than dentists. CONCLUSIONS: Differences in diagnostic strategies and concepts existed within clearly delimited types of cognitive processes; such processes were largely compatible with the analytic and (in particular) non-analytic approaches to clinical decision-making identified in the medical field. Because we were focused on a clinical presentation primarily made up of non-emergency treatment needs, use of other DTPs and concepts might occur when clinicians evaluate emergency treatment needs, complex rehabilitative cases, and/or medically compromised patients. |
format | Text |
id | pubmed-2879228 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2010 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-28792282010-06-02 Diagnostic thinking and information used in clinical decision-making: a qualitative study of expert and student dental clinicians Maupomé, Gerardo Schrader, Stuart Mannan, Saurabh Garetto, Lawrence Eggertsson, Hafsteinn BMC Oral Health Research article BACKGROUND: It is uncertain whether the range and frequency of Diagnostic Thinking Processes (DTP) and pieces of information (concepts) involved in dental restorative treatment planning are different between students and expert clinicians. METHODS: We video-recorded dental visits with one standardized patient. Clinicians were subsequently interviewed and their cognitive strategies explored using guide questions; interviews were also recorded. Both visit and interview were content-analyzed, following the Gale and Marsden model for clinical decision-making. Limited tests used to contrast data were t, χ(2), and Fisher's. Scott's π was used to determine inter-coder reliability. RESULTS: Fifteen dentists and 17 senior dental students participated in visits lasting 32.0 minutes (± 12.9) among experts, and 29.9 ± 7.1 among students; contact time with patient was 26.4 ± 13.9 minutes (experts), and 22.2 ± 7.5 (students). The time elapsed between the first and the last instances of the clinician looking in the mouth was similar between experts and students. Ninety eight types of pieces of information were used in combinations with 12 DTPs. The main differences found in DTP utilization had dentists conducting diagnostic interpretations of findings with sufficient certainty to be considered definitive twice as often as students. Students resorted more often to more general or clarifying enquiry in their search for information than dentists. CONCLUSIONS: Differences in diagnostic strategies and concepts existed within clearly delimited types of cognitive processes; such processes were largely compatible with the analytic and (in particular) non-analytic approaches to clinical decision-making identified in the medical field. Because we were focused on a clinical presentation primarily made up of non-emergency treatment needs, use of other DTPs and concepts might occur when clinicians evaluate emergency treatment needs, complex rehabilitative cases, and/or medically compromised patients. BioMed Central 2010-05-13 /pmc/articles/PMC2879228/ /pubmed/20465826 http://dx.doi.org/10.1186/1472-6831-10-11 Text en Copyright ©2010 Maupomé et al; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Research article Maupomé, Gerardo Schrader, Stuart Mannan, Saurabh Garetto, Lawrence Eggertsson, Hafsteinn Diagnostic thinking and information used in clinical decision-making: a qualitative study of expert and student dental clinicians |
title | Diagnostic thinking and information used in clinical decision-making: a qualitative study of expert and student dental clinicians |
title_full | Diagnostic thinking and information used in clinical decision-making: a qualitative study of expert and student dental clinicians |
title_fullStr | Diagnostic thinking and information used in clinical decision-making: a qualitative study of expert and student dental clinicians |
title_full_unstemmed | Diagnostic thinking and information used in clinical decision-making: a qualitative study of expert and student dental clinicians |
title_short | Diagnostic thinking and information used in clinical decision-making: a qualitative study of expert and student dental clinicians |
title_sort | diagnostic thinking and information used in clinical decision-making: a qualitative study of expert and student dental clinicians |
topic | Research article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2879228/ https://www.ncbi.nlm.nih.gov/pubmed/20465826 http://dx.doi.org/10.1186/1472-6831-10-11 |
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