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Volume 26 (3)

Volume 26, Issue 3, Summer 2006line
J Contin Educ Health Prof 2006; 26(3):192-198
RESEARCH ARTICLE

The difficulty with experience: Does practice increase susceptibility to premature closure?
Kevin W. Eva
John P. W. Cunnington

A b s t r a c t

Introduction: A recent review of the physician performance literature concluded that the risk of prematurely closing one’s diagnostic search increases with years of experience. To minimize confounding variables and gain insight into cognitive issues relevant to continuing education, the current study was performed to test this conclusion.
Methods: Physician participants were shown a series of case histories and asked to judge the probability of a pair of diagnoses. The order in which features were presented was manipulated across participants and the probabilities compared to determine the impact of information order. Two groups of participants were recruited, 1 older than and 1 younger than 60 years.
Results: The probability assigned to a diagnosis tended to be greater when features consistent with that diagnosis preceded those consistent with an alternative than when the same features followed those consistent with the alternative. Older participants revealed a greater primacy effect than less experienced participants across 4 experimental conditions.
Discussion: Physicians with greater experience appear to weigh their first impressions more heavily than those with less experience. Educators should design instructional activities that account for experience-specific cognitive tendencies.

Lessons for Practice
  • With increased experience comes an increased tendency to conclude in favor of one’s first impressions.
  • The extent to which first impressions influence decision making is determined by the presence or absence of a diagnostic suggestion and one’s confidence in the diagnosis.
  • Educators should design continuing education activities that take into account experience-specific cognitive tendencies.
Key Words: Clinical reasoning, aging, clinical experience, nonanalytic processes, information order, continuing education, medical
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