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      Development of Visual Diagnostic Expertise in Pathology: An Information-processing Study

      , , ,
      Journal of the American Medical Informatics Association
      Elsevier BV

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          Knowledge Based Solution Strategies in Medical Reasoning

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            Nature of expertise in searching mammograms for breast masses.

            The authors investigated how training and experience affect the performance of observers searching mammograms for breast masses. Eye positions of mammographers, mammography technologists, mammography residents, and laypersons were compared to scan paths generated by a simulated scanner as each searched nine two-view digital mammogram pairs for breast masses. Analysis of time-to-hit data revealed that mammographers and mammography technologists with the most extensive training and experience had the fastest search times in the detection and confirmation of a breast mass on two views. Scanning patterns of less-experienced mammography residents were less efficient due to wider dispersion of visual attention between potential breast masses and perturbations in breast parenchyma. Because laypersons lacked both training and experience in mammography, bright blobs in the breast image were considered to be intuitively valid target candidates and these features distracted the search by capturing visual attention. Experience reading normal and abnormal mammograms plays a critical role in training radiologists. Experience combined with training provides the basis for generating efficient visual search strategies and developing distinctive conceptual criteria for perceptual differentiation and interpretation of true breast masses from image artifacts and structured noise that mimics breast abnormalities.
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              The development of expertise in dermatology.

              To examine the development of expertise in dermatology, accuracy of diagnosis and response times of subjects at five levels of expertise were assessed. A total of 100 slides, 2 typical and 3 atypical slides from each of 20 common skin disorders, were presented to six subjects at each of the following levels: second-year preclinical medical students, final year medical students, residents in family medicine, general practitioners, and dermatologists. Accuracy of diagnosis rose from 21% for medical students to 87% for dermatologists. Correct diagnosis was associated with a decrease in response time with expertise, whereas errors were associated with a dramatic increase in response time, and was slower than correct response times at all levels, suggesting that errors do not result predominantly from carelessness or speed. Typical slides accounted for a constant proportion of diagnostic errors at all higher levels of expertise, and experts continued to make a significant proportion of errors on slides shown to be relatively easy for residents. The results are shown to be at variance with any model that equates expertise with the mastery of complex rules, but they are consistent with models of expertise that propose that expertise is equated with a rapid "pattern-recognition" process, and errors result from unintended confusion with previous similar examples.
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                Author and article information

                Journal
                Journal of the American Medical Informatics Association
                Journal of the American Medical Informatics Association
                Elsevier BV
                1067-5027
                1527-974X
                January 01 2003
                January 01 2003
                : 10
                : 1
                : 39-51
                Article
                10.1197/jamia.M1123
                12509356
                a9fa38c9-cbfa-4280-8a5c-1597083bf535
                © 2003
                History

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