When less is more: representation and selective memory in expert problem solving.

Few studies of problem-solving expertise in professional domains have undertaken independent assessments of how domain-specific knowledge contributes to the development of problem representations as well as subsequent memory for task information. These issues were investigated in the present study by asking participants at three levels of training and experience (novice, trainee, and expert) in a medical specialty to solve two complex diagnostic problems (patient cases) selected from medical records of a university hospital. The subjects were also asked to provide an incidental free recall of the patient information contained in each case immediately after problem solving and one week later. Problem representations (identified as "lines of reasoning") used by each subject in each case were determined from an analysis of thinking-aloud protocols generated during problem solving. The three groups did not differ on the overall amount of case information recalled at the immediate retention test and did not show selective recall for information statements that were directly relevant to the lines of reasoning used during problem solving. After one week, however, the expert physicians remembered fewer information units than novices but showed selective retention for case information contained in the lines of reasoning used to reach a diagnosis. Experts also increased their recall of specific diagnostic interpretations contained in their initial problem-solving experience while novices did not demonstrate evidence of their problem representations in recalling case information.

Multimethod study of clinical judgment.

Expert and novice clinicians judged the likelihood of disease alternatives and gave thinking-aloud protocols as they evaluated simulated cases of congenital heart disease. Specific combinations of cues in the patient data were manipulated to create alternate versions of a single case so that the use of critical cues could be identified. Analyses of variance of subjects' disease judgments revealed differences between expert and novice clinicians in their use of critical cues and cue combinations. Analyses of the thinking-aloud protocols revealed that clinicians with different degrees of expertise employed different interpretations of patient data cues as well as qualitatively distinct "lines of reasoning" in reaching clinical judgments.