Recent research investigating diagnosis has generally relied upon one of two approaches to categorize and assess the antecedents of diagnostic error: (a) describing diagnostic error as a result of flaws in human cognition or (b) explaining diagnostic error as a result of working with complex health information systems. Each approach has uncovered important features that promote diagnostic error. However, each approach has inherent limitations, and integrating results from one approach to the other has proved difficult. In the current study, a cognitive engineering technique known as work domain analysis was implemented to provide a framework for uncovering the relationship between diagnosis, complex health systems, and theories of cognition and reasoning. The resulting model of diagnosis provides a comprehensive, novel perspective of the diagnostic process that offers a new foundation to formulate empirical inquiries about diagnosis and provides new avenues for the design and development of health information technologies, assessment strategies, and diagnosis-centered simulation paradigms.
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