The Differences of Subjective findings in Pattern Recognition among Experts, Novices and Students: a Quasi-Delphi Technique

Introduction: Experts use forward reasoning to diagnose accurately whereas non-experts prefer to use backward reasoning. Experts develop their hypotheses with pattern recognition before the interview and physical examination, using illness scripts for decision making and diagnosis. Objective: Superior pattern recognition is developed via clinical experience with patients. As a consequence, chunked subjective findings should be more abundant in experts than in novices. The purpose of this study was to clarify the differences in clinical picture between experts and novices in terms of subjective complaints that experts and non-experts look into and focus on when they initially see a patient. Method: Three rounds of questionnaires were administered using in a quasi-Delphi technique concerning two glenohumeral joint problems. Consensus was considered achieved when the distribution of answers had over 75% agreement in the scores. Result: 14 clinicians and 9 students were dropped out during 3 sequential surveys. The consensus was reached in three groups. At the final round, the findings of student group were integrated to 39 for frozen shoulder and 30 for rotator cuff tear. On the other hand, the findings in clinician group were converged to 34 and 36 for frozen shoulder and 28 and 35 findings for rotator cuff tear. Expert group demonstrated the specific example of aggravating factors and area of symptom as subjective findings. Conclusion: C onsensus was achieved in all groups. Main difference between experts and the other groups were found in subjective findings.