How does patient management knowledge integrate into an illness script?

Context: Studies in medical expertise have shown that the medical knowledge of physicians is organized in a way that is easily retrievable when they encounter patients. These knowledge structures, called illness scripts, contain various pieces of information, including signs, symptoms, and enabling conditions, concerning a given disease. Illness script research has principally focused on understanding how physicians make diagnoses, while patient management has received much less attention. Although the work on diagnostics has taught us many things about the nature of medical expertise, focusing solely on this aspect provides only a narrow perspective on the subject, resulting in an incomplete depiction of medical experts. The goal of the present study was to experimentally determine how management knowledge plays a role in the development of illness scripts and developing expertise. Materials and Methods: Medical students, interns, and residents were instructed to think aloud while reading a case with either a diagnostic or management focus. The recall protocols were examined in terms of illness script components, as well as diagnostic and management accuracy. Findings: Both residents and interns were sensitive to the focus and generated significantly more management-items when thinking about management than when they were asked to diagnose a clinical case. They also provided more management items than medical students in management-focus. The performance of interns was superficially similar to that of residents in terms of management proportion, but with respect to both diagnostic and management accuracy they resembled medical students. Medical students, in contrast, were very persistent and insensitive to the focus. Conclusions: Medical expertise could be characterized by the emergence of illness scripts that are rich in terms of management knowledge. Illness scripts can generally be applied to any medical encounter that includes diagnosis and management, and expertise research should be extended to cover both domains.

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