The accuracy of initial diagnostic decision-making under conditions of uncertainty may depend on the ease with which diagnostic hypotheses come to a physician's mind (their “availability”), as well as on physician judgments of their probability and seriousness. This study investigated the above factors as to their effect on physicians' diagnostic performance on simulated clinical cases. In addition, physician judgments of the probability of diagnostic hypotheses were compared to their objective probabilities as determined from hospital records. It was found that the availability order of diagnostic hypotheses was highly related to physicians' judgments of their probability, but not to their judgments of seriousness. The implication is that availability may distort physicians' diagnostic judgments more than does seriousness. Variation was found in physicians' awareness of objective hospital probabilities from simulated case to case. The effect of awareness of objective probabilities on diagnostic accuracy remains to be further investigated.

A new approach to teaching Normal Growth and Development to preclinical medical students is described. By using specially constructed multidisciplinary clinical simulations as training and evaluation devices, students were gradually and simultaneously exposed to: (1) subject matter; (2) the concept of multidisciplinary health care delivery; and (3) the objectives, strategies, and techniques of problem solving and diagnostic reasoning that characterize experienced physicians. The course, designed by a child psychiatrist and medical educators, was taught by a multidisciplinary teaching team drawn from faculty and health care representatives. Student evaluations of the course were favorable.