摘要：Background: If experienced physicians apply clinical rather than biomedical knowledge when diagnosing, why do
we use the basic sciences as the foundation for clinical teaching? In this study our objective was to evaluate the
contribution of biomedical knowledge to diagnostic performance.
Method: We asked 13 medical students and 19 nephrologists to solve electrolyte problems while thinking aloud,
and determined the application of biomedical concepts from protocol analysis. We used logistic regression to
study the association between biomedical concepts, clinical experience, and diagnostic performance.
Results: Students and nephrologists applied a similar number of relevant biomedical concepts per case (M = 1.8
SD = 1.1 vs. M = 1.8, SD = 1.2), respectively, p = 0.80), but nephrologists had better diagnostic performance (86.8%
vs. 63.5%, respectively, p < 0.01). Experience modified the effect of applying biomedical concepts on diagnostic
performance. For students the odds of success increased significantly with applying biomedical concepts (odds
ratio 4.66 [2.07, 10.48], p < 0.001), whereas for nephrologists there was only a trend towards improved
performance (odds ratio 1.72 [0.94, 3.11], p = 0.07).
Conclusions: Our results suggest that improving biomedical knowledge should improve students’ diagnostic
performance on electrolyte problems, but it is unclear if this approach will also be effective in experienced
physicians.
