Expert Physicians Provide More Fluent, Flexible, And Expansive Management Scripts Than Novice Doctors

Year Submitted: 2025
Published Date: 02 February 2026

Tags: Education Research, Learning Theories ＆ Framework, Training ＆ Education

About this Content

Aims

The study aims to explore the differences (if any) in the management scripts of junior doctors versus expert clinicians in the management of chronic diseases.

Background

Key to humanistic medicine is whole person care, where the varied dimensions and needs of a person are recognized. One way for translating this perspective to authentic practice is via looking at continuity of care (CoC). CoC is an important aspect of patient care, yet junior doctors are not taught how to deliver CoC. There is a lack of evidence on how best to teach this competency and the theoretical underpinnings to guide effective teaching interventions. The theoretical underpinnings that can guide the development of effective teaching interventions for CoC have not been well elucidated so far. One possible framework that can inform the development of mental schema for managing a health condition is management scripts. There is little empirical evidence on how management scripts differ across clinicians of varying levels of expertise. Understanding these differences could be a crucial first step in furthering the nascent field of management scripts which may eventually lead to a framework for developing therapeutic reasoning in junior doctors, which is also understudied and less well understood. The current study will advance our knowledge in this field by adding empirical evidence on the differences between management scripts of junior doctors and expert clinicians, using the think-aloud method.

Methods

This is a descriptive qualitative study. 12 junior doctors and 12 consultants will be selected using typical sampling. The PI developed a clinical vignette which is a typical scenario in a community hospital where management decisions for a patient's chronic disease need to be made. A one-to-one interview will be conducted where the clinical vignette is presented to the participant. The participant will be asked to articulate their thoughts about how to proceed in terms of management of the clinical problem and their considerations, in a think-aloud method. Following that, a semi-structured interview to clarify the participants management decisions is conducted. The transcribed interview will be coded inductively and deductively using thematic analysis. Following initial coding and formation of themes, the themes that have been constructed from the junior doctors' data will be compared with those constructed from the expert clinicians.

Results

On average, the consultants had 29.8 years and the junior doctors had 2.3 years of clinical experience. The management scripts of consultants were more fluent, flexible, and expansive. We constructed three main themes: (1) knowledge and foresight enable fluency, (2) realistic and empathetic consideration of patient factors enable flexibility, and (3) expansive boundaries that include other healthcare professionals and settings. There were two sub-themes for each theme. For the first theme, what enabled script fluency was highlighted by the sub-themes of patient-tailored biomedical and process knowledge and prediction of illness trajectory. For the second theme, script flexibility was influenced by realistic modifications based on patient factors and empathy for patient concerns. For the last theme, consultants considered patient management as shared rather than segregated and transition to other healthcare settings to make their scripts more expansive.

Lessons Learnt

Differences in script attributes like fluency and flexibility between junior doctors and consultants have been described in the literature. Poorer fluency in junior doctors could be due to increased cognitive load from the dual-task of the think-aloud protocol. In contrast, consultants possess reproducible schemas for multiple clinical problems that reduce cognitive load and improve fluency. Adaptive expertise could also explain both the fluency and flexibility in the consultants' scripts. Consultants demonstrated the ability to work within an optimal adaptability corridor, where they balance the efficiency and innovative aspects of problem solving. Literature shows that faculty, compared to residents, adopt additional elements of continuity of care and initiative, which could explain their more expansive professional boundaries. These results can inform focus areas for teaching of CoC to junior doctors, namely: (1) Teach both disease-specific and process knowledge, (2) Expose junior doctors to varied patient presentations, and (3) Make explicit that patient ownership involves both providing and coordinating care.

Additional Information

1. Poster presentation at Singapore Health and Biomedical Congress 2025. Awarded Gold for Best Poster Award (Health Professions Education)
2. Oral presentation (Free Comms) at Asia Pacific Medical Education Conference 2026. Awarded Best Oral Presenter Scholar (Merit)

Keywords

Continuity of Care, Management scripts, Adaptive Expertise

Innovators' Details

Connect with this contributor!

Yap Kwee Yong Joyce - joyce.ky.yap@nhghealth.com.sg

Project Attachment

166_NTUC_Health_NHIP_2024_Digitalisation_of_NTUC_Health_Active_Ageing_Centres_Operations.pdf