A primer on aspects of cognition for medical informatics

Abstract

As a multidisciplinary field, medical informatics draws on a range of disciplines, such as computer science, information science, and the social and cognitive sciences. The cognitive sciences can provide important insights into the nature of the processes involved in human- computer interaction and help improve the design of medical information systems by providing insight into the roles that knowledge, memory, and strategies play in a variety of cognitive activities. In this paper, the authors survey literature on aspects of medical cognition and provide a set of claims that they consider to be important in medical informatics.

Figure 1

Epistemological framework representing the structure of medical knowledge for problem solving.

Figure 2

Idealized representation of the intermediate effect, a finding reported in many studies of expertise, learning, and cognitive development. The straight line gives a commonly assumed representation of performance development by level of expertise. The curved line represents the actual development from novice to expert. The Y-axis may represent any of a number of performance variables, such as the number of errors made, number of irrelevant concepts recalled, number of conceptual elaborations, or number of extraneous hypotheses generated in a variety of tasks.

Figure 3

Comparison between the concepts generated by a cardiologist (expert) and an endocrinologist (sub-expert) on three pieces of clinical information (problem segments) specific to a cardiology task.

Figure 4

Diagrammatic representation of data-driven (top) and hypothesis-driven reasoning (bottom). From the presence of vitiligo, a prior history of progressive thyroid disease, and examination of the thyroid (clinical findings on the left), the physician reasons forward to conclude the diagnosis of myxedema (on the right). However, the anomalous finding of respiratory failure, which is inconsistent with the main diagnosis, is accounted for as a result of a hypometabolic state of the patient, in a backward-directed fashion. COND indicates a conditional relation; CAU, a causal relation; RSLT, a resultive relation.