The Acquisition of Perceptual Diagnostic Skill in Radiology.
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Abstract : Five experts, each with at least ten years of on-the-job experience since their residencies, and eighteen radiology residents in the first through fourth years of training diagnosed five standard chest X-ray pictures. Verbal protocols were collected, and an in-depth qualitative analysis of the protocols was performed. One of the most striking differences between the experts and the residents was in the ability of more experienced subjects to see anatomy; that is, to build a rich mental representation of the anatomy of the patient whose radiograph is being diagnosed. There were ability-related differences in the extent to which general diagnostic schemas were directly triggered by abnormality features. In many cases, experts detected a general pattern of disease that severely constrained the possible interpretations of otherwise ambiguous film abnormalities. We concluded that developing a representation of the patient is more of a recursive process in experts. That is, initial film features are recognized as signs of abnormality. They, in turn, drive higher-level reasoning about the likely sources of disease, and that reasoning in turn sets the stage for further feature recognition. This recursion through the different stages of the diagnosis process is most successful and occurs in richer forms in experts.