Table 2 Operationalized definition of the diagnostic knowledge dimensions

Conceptual knowledge, “what”- information

Statements of facts, repeated information. Causal knowledge or deductive reasoning without explanations.

Examples: “Leucocytes of 2000? The reference value was approximately 10,000?”; “Antibiotics can cause red urine as well”; “Nephrotic syndrome consists of proteinuria, hypalbumin- and dislipidaemia and edema”.

Strategic knowledge, “how”-information

Knowledge about actions. Explanations, why one prefers this action. Strategic use of concepts.

Examples: “May I have an ECG?”; “First, I would like to know how many cigarettes he consumes”; “Do we have a urine sample? Since it is a cheap and quick investigation, we should do that”; “One could make an ultrasound scan in order to identify free fluid”.

Conditional knowledge, “why”-information

Relationships between facts. Inductive reasoning, several facts are taken together in order to derive a judgement. Explanations of concepts without strategic use of those concepts.

Examples: “He has a cirrhosis of the kidney, and he already has anaemia and diabetes. Taken together, he has chronic kidney failure”; “Chronic kidney failure – due to this, the RAAS is activated causing the hypertension. This is the reason why medication doesn't help”.

Metacognitive knowledge “selfcognition” -information

The meta-level (metacognition) receives information from object-level (case-work). Consciousness about information and state of cognitions. Summaries and assessment of information, self-assessment, comparison of new information with the mental representation of the case. The meta-level (metacognition) modifies the object-level (case-work). Intervention into the process of working on the case. Something changes, or not, but with intention.

Examples: “What have we got so far?”, “I think this is correct. I'm not completely sure, but I think it is okay”; “Oh, there really is blood in the urine, as I had assumed before”