On the constraints of encapsulated knowledge: Clinical case representations by medical experts and subexperts

This article is concerned with the role of so-called encapsulated knowledge and biomedical knowledge in the process of diagnosing clinical cases within and outside the medical specialist's domain of expertise. Based on the theory of knowledge encapsulation, we predicted that subexperts (i.e., medical specialists diagnosing a clinical case outside their specialty) could not diagnose a clinical case in an encapsulated mode, and therefore they would relapse into an elaborate biomedical processing approach to understand the described signs and symptoms. Cardiologists (the experts) and Neurologists (the subexperts) were instructed to study 2 clinical case descriptions for a period of 3 min per case. After each case they were asked to provide a diagnosis, write down everything they remembered of the case, and finally to explain the signs and symptoms displayed in the case. The results show that cardiologists achieved a higher diagnostic accuracy than did neurologists. Furthermore, the cardiologists' recall and pathophysiological explanations contained more high-level inferences (i.e., encapsulations) than those of neurologists. These outcomes are in line with the predictions made on the basis of the theory of knowledge encapsulation.