Problem solving in paediatric medicine: An analysis of student and consultant diagnostic skills

Abstract

A study was undertaken to examine the similarities among and differences between the process of problem solving by undergraduate medical students and experienced consultants in the area of paediatric medicine. To approximate the clinical situation, a naturalistic study was carried out. Patients were chosen from those attending a consultant medical outpatient department of a teaching hospital and selected because of their relatively common paediatric problems. A videotape recording was made of the patient- student/consultant encounter to facilitate subsequent analysis. The students/consultants were also asked to complete a prescribed protocol detailing their hypotheses or diagnoses at various stages of the interview and after completion of the examination. Their judgement as to how they had learned these skills in problem solving was also sought. Both students and consultants used a hypothetico-deductive method of problem solving, generating multiple hypotheses early within the patient encounter. However students, in contrast with the consultants, considered a greater number of hypotheses but did not, carry out an efficient inquiry strategy. They often arrived at an incorrect final diagnosis, despite having earlier considered the correct diagnosis. The experienced consultant on the other hand raised fewer. hypotheses, was more selective in his subsequent hypothesis testing and arrived at the final correct diagnosis. The consultants also seemed more understanding of the importance of the child within his family, which was particularly relevant in the assessment of the child with biopsycho-social symptoms. All students when reflecting on how they had learnt their problem solving skills, Included formal learning in their response. In contrast the experienced consultants all cited Independent learning. The observation of an appropriate clinical model was reported equally by both students and consultants. Discussion centres around these findings with additional consideration being given as to whether problem solving skills may be learnt.