role of basic science knowledge and

The Role of Basic Science Knowledge and Clinical Knowledge in Diagnostic

Reasoning

The Role of Basic Science Knowledge and Clinical Knowledge in

Diagnostic Reasoning: A Structural Equation Modeling Approach

From Academic Medicine (2005) 80: 765-773.

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