Case representation by medical experts, intermediates and novices for laboratory data presented with or without a clinical context

Background  Based on cognitive psychological research, a number of theoretical frameworks have been put forward to describe the structure of experts’ medical knowledge and to explain experts’ case‐processing. Purpose  To provide evidence for the theory of knowledge encapsulation, which states that medical knowledge constitutes of interlinked biomedical and clinical knowledge. Methods  Fourth‐year medical students, clerks and medical experts evaluated six case descriptions, consisting of laboratory data either with or without a clinical context. For each case description, the participants were required to study the case, to formulate a diagnosis, and to write down everything they could remember of the case. Results  When the laboratory data were not embedded within a clinical context, medical experts’ case‐processing increased and their diagnostic accuracy became worse. Furthermore, laboratory data recall of medical experts was more elaborate in cases where the laboratory data were presented without a clinical context. Similar results were obtained for students and clerks. Conclusions  The findings are only partially consistent with a prediction made by the theory of knowledge encapsulation. Further research, using a different paradigm than the traditionally used method of free recall, is required to unearth whether medical experts use qualitatively different knowledge structures than novices while solving cases.