Intuitive and deliberative approaches for diagnosing ‘well’ versus ‘unwell’: evidence from eye tracking, and potential implications for training

Rapidly assessing how ill a patient is based on their immediate presentation—colloquially termed ‘eyeballing’ in practice—serves a vital role in acute care settings. Yet surprisingly little is known about how this diagnostic skill is learned or how it should be taught. Some authors have pointed to a dual-process model, suggesting that assessments of illness severity are driven by two distinct types of processing: an intuitive, fast, pattern recognition-like process (Type 1) that depends on many prior patient encounters and outcomes being stored in memory; and a deliberate, slow, analytic process (Type 2) characterized by additional data gathering, data scrutiny, or recollection of rules. But prior studies have supported a dual-process model for the assessment of illness severity only insofar as experienced clinicians chiefly displayed what was presumed to be Type 1 processing. Here we further explored a dual-process model by examining whether less experienced clinicians displayed both types of processing when assessing illness severity across a series of cases. Consistent with the model, a dissociation between Type 1 and Type 2 processing was observed through resident reports of deliberation, response times, and three eye tracking metrics associated with diagnostic expertise. We conclude by discussing potential implications for the training of this enigmatic diagnostic skill.