Using Experience in Clinical Problem Solving: Introduction and Framework

While much recent interest exists in the cognitive processes involved in clinical reasoning, a much-neglected area is the role of experience in diagnosis and treatment. A model of experience's role in commonsense problem solving is developed and a model of clinical reasoning that incorporates experience is proposed. Understanding the role of experience in clinical reasoning has two important implications. First, it will enable the building of better computerized reasoning systems for decision support and advisement. Such systems will be easy for clinicians to follow and will be able to take advantage of the similarities between novel cases in their reasoning. Second, it will enable the development of more effective teaching strategies that might result in more efficient learning environments and more accurate and reliable clinical reasoning. Two major contributions that experience makes to problem solving are identified. First, it provides exemplars to aid in hypothesis formation during classification, plan selection, and error recovery. Second, it triggers and contributes to refinement and modification of problem-solving knowledge. A model of the interaction between problem solving and experience is presented, including reasoning processes that make use of previous experience and a well-developed memory model that allows retrieval of individual experiences from memory as needed. The components of clinical reasoning are placed into the problem-solving model and thus propose places in the clinical reasoning cycle where one expects to see each experiential reasoning component.