Development of an Expert System to Teach Diagnostic Skills

The primary purpose of the study was to develop an expert system that could C D perform medical diagnoses In selected problem areas, and C2) provide diagnostic Insights to assist medical students In their training. An expert system Is a computer-based set of procedures and algorithms that can solve problems In a given domain. Two research questions were proposed. The first was "Given a problem space defined by a matrix of diseases and symptoms, can a computer-based model be derived that will consistently perform accurate and efficient diagnoses of cases within that problem area?" The second question was "If the techniques derived from the model are taught to a medical student, is there a subsequent improvement of diagnostic skill?" An expert system was developed which met the objectives of the study. It was able to diagnose cases in the two problem areas studied with an accuracy of 94-95%. Furthermore, it was able to perform those diagnoses in a very efficient manner, often using no more than the theoretical minimum number of steps. The expert system employed three phases: rapid search by discrimination, confirmation by pattern matching against prototypes, and elimination of some candidates (impossible states) by making use of negative information. The discrimination phase alone achieved accuracies of 73-78%. By comparison, medical students achieved mean accuracies of 54-55% in the same problem areas. This suggests that novices could improve their diagnostic accuracy by approximately 20% by following the simple rules used in the first phase of the expert system. Curricular implications are discussed. When 49 first-year medical students at the Texas College of Osteopathic Medicine were exposed to some of the insights of the expert system by means of a videotaped 10- minute lecture, their diagnostic approach was modified and the accuracy of their diagnoses did improve. However, the degree of Improvement was not statistically significant. Recommendations for further research are made