Meta-design Knowledge for Clinical Decision Support Systems

Knowledge gained from a Decision Support Systems (DSS) design should ideally be reusable by DSS designers and researchers. The majority of existing DSS research has mainly focused on empirical problem solving rather than on developing principles that could inform solution approaches for other user contexts. Design Science Research (DSR) has contributed to effective development of various innovative DSS artifacts and associated knowledge development, but there has been limited progress on new knowledge development from a practical problem context, going beyond product and process descriptions. For DSS applications such as Clinical Decision Support Systems (CDSS) design and development, relevant reusable prescriptive knowledge is of significance not only to understand mutability but also to extend application of theory across domains. In this paper, we develop new design knowledge abstracted from the approach taken in a representative case of innovative CDSS development, specified as an architecture and six design principles. The CDSS design artifact was initially designed for a specific clinical need is shown to be flexible for meeting demands of knowledge production both for diagnosis and treatment. It is argued that the proposed general strategy is applicable to designing CDSS artifacts in similar problem domains representing an important contribution of design knowledge both in DSS and DSR fields

Diagnostic Palpation in Osteopathic Medicine: A Putative Neurocognitive Model of Expertise

This thesis examines the extent to which the development of expertise in diagnostic palpation in osteopathic medicine is associated with changes in cognitive processing. Chapter 2 and Chapter 3 review, respectively, the literature on the role of analytical and non-analytical processing in osteopathic and medical clinical decision making; and the relevant research on the use of vision and haptics and the development of expertise within the context of an osteopathic clinical examination. The two studies reported in Chapter 4 examined the mental representation of knowledge and the role of analogical reasoning in osteopathic clinical decision making. The results reported there demonstrate that the development of expertise in osteopathic medicine is associated with the processes of knowledge encapsulation and script formation. The four studies reported in Chapters 5 and 6 investigate the way in which expert osteopaths use their visual and haptic systems in the diagnosis of somatic dysfunction. The results suggest that ongoing clinical practice enables osteopaths to combine visual and haptic sensory signals in a more efficient manner. Such visuo-haptic sensory integration is likely to be facilitated by top-down processing associated with visual, tactile, and kinaesthetic mental imagery. Taken together, the results of the six studies reported in this thesis indicate that the development of expertise in diagnostic palpation in osteopathic medicine is associated with changes in cognitive processing. Whereas the experts’ diagnostic judgments are heavily influenced by top-down, non-analytical processing; students rely, primarily, on bottom-up sensory processing from vision and haptics. Ongoing training and clinical practice are likely to lead to changes in the clinician’s neurocognitive architecture. This thesis proposes an original model of expertise in diagnostic palpation which has implications for osteopathic education. Students and clinicians should be encouraged to appraise the reliability of different sensory cues in the context of clinical examination, combine sensory data from different channels, and consider using both analytical and nonanalytical reasoning in their decision making. Importantly, they should develop their skills of criticality and their ability to reflect on, and analyse their practice experiences in and on action