The role of encapsulated knowledge in clinical case representations of medical students and family doctors

BACKGROUND Previous studies on the development of medical expertise, predominantly using measures of free recall and pathophysiological explanations, have shown ambiguous results concerning the relationship between expertise level and encapsulated knowledge. PURPOSE To investigate differences in clinical case representations by medical students and family doctors. In particular, the role of encapsulated knowledge in clinical case representations was investigated. METHODS Year 2 (n = 15) and Year 4 (n = 15) medical students and family doctors (n = 15) were instructed to study carefully 2 case descriptions associated with a particular disease. After each case description participants were asked to provide a diagnosis. Subsequently, they judged whether or not a target item presented on a computer screen was related to the case description. Target items consisted of literally stated signs and symptoms, inferred encapsulated items and filler items. RESULTS Family doctors provided more accurate diagnoses than Year 2 and Year 4 medical students. Furthermore, family doctors were faster and made fewer errors in judging the relatedness of all item types than Year 2 and 4 medical students. In particular, family doctors showed their best performance on the encapsulated items. CONCLUSIONS The present study showed that encapsulated knowledge becomes increasingly more prominent as expertise develops. For experienced doctors, encapsulated concepts function as the most important building blocks of clinical case representations.