How Do Physicians Become Medical Experts? A Test of Three Competing Theories: Distinct Domains, Independent Influence and Encapsulation Models

Autor/inn/en	Violato, Claudio; Gao, Hong; O'Brien, Mary Claire; Grier, David; Shen, E.
Titel	How Do Physicians Become Medical Experts? A Test of Three Competing Theories: Distinct Domains, Independent Influence and Encapsulation Models
Quelle	In: Advances in Health Sciences Education, 23 (2018) 2, S.249-263 (15 Seiten)Infoseite zur Zeitschrift PDF als Volltext Verfügbarkeit
Sprache	englisch
Dokumenttyp	gedruckt; online; Zeitschriftenaufsatz
ISSN	1382-4996
DOI	10.1007/s10459-017-9784-z
Schlagwörter	Physicians; Expertise; Longitudinal Studies; Structural Equation Models; Grade Point Average; Undergraduate Students; College Entrance Examinations; Medical Schools; Statistical Analysis; Competence; Knowledge Level; Influences; Medical College Admission Test + Suchen Sie Ihr Suchwort? Physician; Doctor; Arzt; Expert appraisal; Longitudinal study; Longitudinal method; Longitudinal methods; Längsschnittuntersuchung; Aufnahmeprüfung; Medizinische Ausbildung; Statistische Analyse; Kompetenz; Wissensbasis; Influence; Einfluss; Einflussfaktor
Abstract	The distinction between basic sciences and clinical knowledge which has led to a theoretical debate on how medical expertise is developed has implications for medical school and lifelong medical education. This longitudinal, population based observational study was conducted to test the fit of three theories--knowledge encapsulation, independent influence, distinct domains--of the development of medical expertise employing structural equation modelling. Data were collected from 548 physicians (292 men--53.3%; 256 women--46.7%; mean age = 24.2 years on admission) who had graduated from medical school 2009-2014. They included (1) Admissions data of undergraduate grade point average and Medical College Admission Test sub-test scores, (2) Course performance data from years 1, 2, and 3 of medical school, and (3) Performance on the NBME exams (i.e., Step 1, Step 2 CK, and Step 3). Statistical fit indices (Goodness of Fit Index--GFI; standardized root mean squared residual--SRMR; root mean squared error of approximation--RSMEA) and comparative fit (X[superscript 2][subscript D], X[superscript 2]) of three theories of cognitive development of medical expertise were used to assess model fit. There is support for the knowledge encapsulation three factor model of clinical competency (GFI = 0.973, SRMR = 0.043, RSMEA = 0.063) which had superior fit indices to both the independent influence and distinct domains theories (X[superscript 2][subscript 29] = 88.11 vs X[superscript 2][subscript 29] = 443.91 [X[superscript 2][subscript D] = 355.80] vs X[superscript 2][subscript 29] = 514.93 [X[superscript 2][subscript D] = 426.82], respectively). The findings support a theory where basic sciences and medical aptitude are direct, correlated influences on clinical competency that encapsulates basic knowledge. (As Provided).
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Erfasst von	ERIC (Education Resources Information Center), Washington, DC
Update	2020/1/01