- Link:
- http://hdl.handle.net/1765/17795
- Collection:
-
- Subjects
- *diagnosis *internship and residency Clinical competence/*standards Clinical medicine/*education Decision making Mental processes Students, medical/*psychology
- Creators:
- Heemskerk, L. Ainslie, M. Rikers, R.M.J.P. Schmidt, H.G. McLaughlin, K.J. Herman, R.
- Description
- Context: Previous studies have shown that an
initial diagnostic hypothesis biases automatic information
processing. It is unclear if an initial hypothesis has a similar
effect on analytic information processing. Our first objective was
to study the effect of an initial diagnostic hypothesis on analytic
processing. Our second objective was to assess the effect of
clinical experience on analytic processing by evaluating the effect
of clinical frequency and urgency of an alternative diagnosis on
diagnosis selection. Methods: During a 12-minute objective
structured clinical examination station, 19 subspecialty medical
residents diagnosed the cause of 3 clinical presentations:
dyspnoea; headache, and chest pain. Subjects were randomly
allocated cases for which the suggested initial hypothesis was
either correct or incorrect. For cases with an incorrect initial
hypothesis, the alternative diagnoses varied in the frequency with
which they are encountered in clinical practice, and their clinical
urgency, relative to the initial diagnostic hypothesis. Results:
All correct initial hypotheses were retained, compared with 10.9%
of incorrect hypotheses. All cases with a correct initial
hypothesis were diagnosed correctly, compared with 65.2% of cases
with an incorrect hypothesis (risk ratio 1.5 [95% confidence
interval 1.2-1.9], P = 0.02). Clinical frequency and urgency were
not associated with alternative diagnosis selection. Discussion:
Our results suggest that an initial diagnostic hypothesis biases
analytic processing. The data used to reject an initial hypothesis
appear to drive selection of an alternative hypothesis. Further
studies aimed at finding strategies for increasing the likelihood
of generating a correct initial hypothesis or debiasing an initial
hypothesis are needed.
- Source
- Medical Education, 2008, Vol. 42(5), pp
496-502
- Type
- Article
- Publisher
- Wiley-Blackwell
- Language
- en
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- 1
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