Novice, Generalist, and Expert Reasoning During Clinical Case Explanation: A Propositional Assessment of Knowledge Utilization and Application
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Objectives: The aim of the two exploratory studies presented here, was to investigate expert-novice cognitive performance in the field of dietetic counseling. More specifically, the purpose was to characterize the knowledge used and the cognitive reasoning strategies of expert, intermediate and novice dietitians during their assessment of clinical vignettes of simulated dyslipidemia cases. Background: Since no studies have been conducted on the expert-novice differences in knowledge utilization and reasoning in the field of dietetics, literature from various domains looking at expert-novice decision-making was used to guide the studies presented here. Previous expert-novice research in aspects of health such as counseling and diagnostic reasoning among physicians and nurses has found differences between in the way experts extract and apply knowledge during reasoning. In addition, various studies illustrate an intermediate effect, where generalist performance is somewhat poorer than that of experts and novices. Methods: The verbal protocols of expert (n=4), generalist (n=4), and novice (n=4) dietitians were analyzed, using propositional analysis. Semantic networks were generated, and used to compare reasoning processes to a reference model developed from an existing Dyslipidemia care map by Brauer et al, (2007, 2009). Detailed analysis was conducted on individual networks in an effort to obtain better understanding of cue utilization, concept usage, and overall cohesiveness during reasoning. Results: The results of the first study indicate no statistical differences in reasoning between novices, generalist and experts with regards to recalls and inferences. Interesting findings in the study also suggest that discussions of the terms “dietary fat” and “cholesterol” by individuals in each level of expertise had qualitative differences. This may be reflective of the information provided in the case scenearios to each participating dietitian. Furthermore, contrary to previous studies in expert-novice reasoning, an intermediate effect was not evident. The results of the second study show a statistical difference in data driven (forward) reasoning between experts and novices. There was no statistical difference in hypothesis driven (backward) reasoning between groups. The reasoning networks of experts appear to reveal more concise explanations of important aspects related to dyslipidemia counseling. Reasoning patterns of the expert dietitians appear more coherent, although there was no statistical difference in the length or number of reasoning chains between groups. With previous research focusing on diagnostic reasoning rather than counseling, this finding may be a result of the nature of the underlying task. Conclusion: The studies presented here serve as a basis for future expert-novice research in the field of dietetics. The exploration of individual verbal protocols to identify characteristics of dietitians of various levels of expertise, can provide insight into the way knowledge is used and applied during diet counseling. Subsequent research can focus on randomized sample selection, with case scenarios as a constant, in order to obtain results that can be generalized to the greater dietitian population.