Traditional information-processing accounts of the reasoning process in radiology assume that humans process the details of the input image in order to compute judgments. In these accounts, the development of expertise involves the acquisition of increasingly precise and complex internal problem representations that are based on a normal anatomy prototype. Fuzzy-trace theory predicts that accurate judgments rely on the reasoners ability to ignore irrelevant detail, to retrieve relevant gist memories and to accurately instantiate the image information with respect to the internal representation. Fuzzy-trace theory predicts that the development of expertise involves the ability to access and process less precise and complex internal representations (i.e., gist). The purpose of this study was to examine the internal representations used to make judgments in radiology and to quantify the changes in complexity of the internal representations, as well as the differences in time, accuracy and confidence that might be associated with experience. Thirty-five subjects from general and specialized expertise samples participated. Each subject was presented with 32 chest films including normal films, films with precise disease patterns (mass category) and diffuse disease patterns (interstitial and airspace category). For each film, the participant made a series of judgments (normal/abnormal; category; specific diagnosis) and then sketched the features that were essential to the judgments. The information content and complexity of the representations were calculated using an approach that considered the underlying meaning of the sketches rather than the surface form. The sketches were converted to propositions and the information in the propositions was evaluated in terms of possible world semantics. Time, accuracy, confidence and content measures supported the prediction of fuzzy-trace theory that the internal representations are abnormality-based. Consistent with predictions regarding the acquisition and use of gist representations expertise was associated with greater improvements in accuracy for interstitial (as opposed to mass) films; accuracy was higher with interstitial films when judgments were less reliant on surface detail (normal/abnormal); and accuracy was higher for mass films when judgments were more reliant on surface detail (specific diagnosis). Complexity measures showed that the overall representations did not get more complex with the development of expertise.
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