gms | German Medical Science

15. Grazer Konferenz – Qualität der Lehre: Teaching and Learning – Expanding our Resources

28. - 30. April 2011, Wien, Österreich

Dual Processing Models of Clinical Reasoning


Suche in Medline nach

  • corresponding author Geoff Norman - McMaster University, Clinical Epidemiology and Biostatistics, Hamilton, Canada

15. Grazer Konferenz – Qualität der Lehre: Teaching and Learning – expanding our resources. Wien, Österreich, 28.-30.04.2011. Düsseldorf: German Medical Science GMS Publishing House; 2012. Doc11grako14

doi: 10.3205/11grako14, urn:nbn:de:0183-11grako143

Veröffentlicht: 25. April 2012

© 2012 Norman.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen ( Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.



When asked how long after graduation from their medical specialty before they felt competent in their job, most physicians report 5-10 years. When asked to choose a family physician from two candidates, one who is a recent graduate and a second who has been in practice 10 years, virtually everyone chooses the latter.

Paradoxically, studies of recertification and relicensure performance based on written examinations uniformly show a linear drop with years from graduation. Evidently, practical experience is contributing substantially to our perception of competence, but its effects are not detectable by formal examinations.

In this talk, I explore the nature of diagnosis from a cognitive psychology perspective, using dual processing theory. I argue from evidence that diagnosticians have two parallel reasoning strategies: a rapid process based on an unconscious “similarity” match “ with previous examples and a slow, logical and conscious strategy based on application of DSM-like rules.

A major role of experience is to provide the expert with a vast mental storehouse of clinical examples, and the act of routine diagnosis, just like everyday categorization of objects like dogs or trees, proceeds primarily by an unconscious mental similarity matching against a previous example in memory. The careful, systematic, deliberate application of diagnostic rules is a secondary process used for confirmation or when the correct diagnosis is not evident. I discuss the implications for clinical teaching.