Biomedical knowledge in diagnostic thinking: The case of electrocardiogram (ECG) interpretation

The role of biomedical knowledge concerning underlying anatomy and pathophysiology in diagnosis has been the subject of considerable controversy in the study of medical expertise. The issue is examined in the present paper in the context of electrocardiogram (EGG) interpretation. A study is reported of three levels of expertise in the diagnosis, explanation and recall of ECG traces varying in difficulty of diagnosis. Expertise effects were found in diagnostic accuracy and confidence and in incidental ECG trace recall following diagnosis. Analyses of think-aloud protocols indicated that biomedical thinking was more prevalent in the ECG domain for experts versus less skilled subjects and in explanation versus diagnostic tasks. Biomedical knowledge was mainly invoked to evaluate possible diagnoses.