Clinical decision-making in restorative dentistry. content-analysis of diagnostic thinking processes and concurrent concepts used in an educational environment

Gerardo Maupome, Aubrey Sheiham

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

Context: Dental practice is affected by variation in diagnosis and treatment planning between clinicians. The process underlying the decisions leading to management of dental caries is poorly understood. Objective: To explore diagnostic thinking and identify information used in the diagnosis, management and treatment of caries. Subjects/materials: 15 senior dental students (mean age, 23.1 years; 66% female) in Mexico City were interviewed using a Simulated Patient Model (SPM). Methods: The SPM consultation session and its review, aimed at eliciting an introspective recall description of the Diagnostic Thinking Processes (DTP) and the pieces of information (concepts) employed, were transcribed and content-analyzed (CA). CA reproducibility coefficients were 0.53 to 0.64. The cognitive psychology Gale & Marsden (GM) model was used to structure DTP and concepts. Data were analyzed with chi-squared tests. Results: DTP utilization was similar to the original report in endocrinology and neurology cases. A wide variety of concepts were combined with DTP to describe the strategies and information preferentially resorted to while addressing four areas identified in the consultation. Conclusions: Narrow arrays of concepts of restorative concern (mostly physical features present in/on teeth) were often investigated using DTP 1, 2 and 4 in combination with the use of dental explorers. The heuristics detected link features common to the GM model and to an indirect pattern-recognition model, whereby reliance on visual/tactile concepts facilitates the acquisition of a clinically meaningful image. Non-clinical factors believed to be at play in the application of strategies were not investigated but were controlled for in the SPM.

Original languageEnglish (US)
Pages (from-to)143-152
Number of pages10
JournalEuropean Journal of Dental Education
Volume4
Issue number4
DOIs
StatePublished - 2000
Externally publishedYes

Fingerprint

dentistry
Dentistry
content analysis
diagnostic
decision making
Tooth
Referral and Consultation
neurology
Dental Students
pattern recognition
Endocrinology
Touch
Dental Caries
Neurology
Mexico
management
Clinical Decision-Making
Thinking
heuristics
psychology

Keywords

  • Clinical decision-making
  • Cognitive psychology
  • Dental education
  • Diagnostic thinking
  • Restorative dentistry
  • Treatment
  • Treatment appropriateness

ASJC Scopus subject areas

  • Dentistry(all)
  • Education

Cite this

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title = "Clinical decision-making in restorative dentistry. content-analysis of diagnostic thinking processes and concurrent concepts used in an educational environment",
abstract = "Context: Dental practice is affected by variation in diagnosis and treatment planning between clinicians. The process underlying the decisions leading to management of dental caries is poorly understood. Objective: To explore diagnostic thinking and identify information used in the diagnosis, management and treatment of caries. Subjects/materials: 15 senior dental students (mean age, 23.1 years; 66{\%} female) in Mexico City were interviewed using a Simulated Patient Model (SPM). Methods: The SPM consultation session and its review, aimed at eliciting an introspective recall description of the Diagnostic Thinking Processes (DTP) and the pieces of information (concepts) employed, were transcribed and content-analyzed (CA). CA reproducibility coefficients were 0.53 to 0.64. The cognitive psychology Gale & Marsden (GM) model was used to structure DTP and concepts. Data were analyzed with chi-squared tests. Results: DTP utilization was similar to the original report in endocrinology and neurology cases. A wide variety of concepts were combined with DTP to describe the strategies and information preferentially resorted to while addressing four areas identified in the consultation. Conclusions: Narrow arrays of concepts of restorative concern (mostly physical features present in/on teeth) were often investigated using DTP 1, 2 and 4 in combination with the use of dental explorers. The heuristics detected link features common to the GM model and to an indirect pattern-recognition model, whereby reliance on visual/tactile concepts facilitates the acquisition of a clinically meaningful image. Non-clinical factors believed to be at play in the application of strategies were not investigated but were controlled for in the SPM.",
keywords = "Clinical decision-making, Cognitive psychology, Dental education, Diagnostic thinking, Restorative dentistry, Treatment, Treatment appropriateness",
author = "Gerardo Maupome and Aubrey Sheiham",
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AU - Sheiham, Aubrey

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N2 - Context: Dental practice is affected by variation in diagnosis and treatment planning between clinicians. The process underlying the decisions leading to management of dental caries is poorly understood. Objective: To explore diagnostic thinking and identify information used in the diagnosis, management and treatment of caries. Subjects/materials: 15 senior dental students (mean age, 23.1 years; 66% female) in Mexico City were interviewed using a Simulated Patient Model (SPM). Methods: The SPM consultation session and its review, aimed at eliciting an introspective recall description of the Diagnostic Thinking Processes (DTP) and the pieces of information (concepts) employed, were transcribed and content-analyzed (CA). CA reproducibility coefficients were 0.53 to 0.64. The cognitive psychology Gale & Marsden (GM) model was used to structure DTP and concepts. Data were analyzed with chi-squared tests. Results: DTP utilization was similar to the original report in endocrinology and neurology cases. A wide variety of concepts were combined with DTP to describe the strategies and information preferentially resorted to while addressing four areas identified in the consultation. Conclusions: Narrow arrays of concepts of restorative concern (mostly physical features present in/on teeth) were often investigated using DTP 1, 2 and 4 in combination with the use of dental explorers. The heuristics detected link features common to the GM model and to an indirect pattern-recognition model, whereby reliance on visual/tactile concepts facilitates the acquisition of a clinically meaningful image. Non-clinical factors believed to be at play in the application of strategies were not investigated but were controlled for in the SPM.

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