Abstract
Introduction: Master clinicians are a group of physicians recognized in large part for their superior diagnostic reasoning abilities. However, their reasoning skills have not been rigorously and quantitatively compared to other clinicians using a validated instrument.Methods: We surveyed Internal Medicine physicians at the University of Iowa to identify the master clinicians. These master clinicians were administered the Diagnostic Thinking Inventory, along with an equivalent number of their peers in the general population of internists. Scores were tabulated for structure and thinking, as well as four previously identified elements of diagnostic reasoning (data acquisition, problem representation, hypothesis generation, and illness script search and selection). The 2-sample t-test was used to compare scores between the two groups.Results: 17 master clinicians were identified, of whom 17 (100%) completed the inventory. 19 out of 25 randomly-selected internists also completed the inventory (76%). Mean total scores were 187.2 and 175.8 for the Master Clinician (MC) and the Internist (IM) groups respectively. Thinking and structure subscores were 91.5 and 95.71 for MCs, compared to 85.5 and 90.3 for IMs (p-values: 0.0783 and 0.1199, respectively). The mean data acquisition, problem representation, hypothesis generation, and illness script selection subscores for MCs were 4.46, 4.57, 4.71, and 4.46, compared to 4.13, 4.38, 4.45, and 4.13 in the IM group (p-values: 0.2077, 0.4528, 0.095, and 0.029, respectively). Conclusions: Master Clinicians have greater proficiency in searching for and selecting illness scripts compared to their peers. There were no statistically significant differences between the other scores and subscores. These results will help to inform continuing medical education efforts to improve diagnostic reasoning.
Diagnostic Reasoning by Master Clinicians: What Distinguishes Them From Their Peers?
