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Experienced physicians benefit from analyzing initial diagnostic hypotheses
- Source :
- Canadian Medical Education Journal, Vol 4, Iss 1 (2013), Canadian Medical Education Journal, 4(1), e7-e15, Canadian Medical Education Journal, Europe PubMed Central
- Publication Year :
- 2013
- Publisher :
- Canadian Medical Education Journal, 2013.
-
Abstract
- Background: Most incorrect diagnoses involve at least one cognitive error, of which premature closure is the most prevalent. While metacognitive strategies can mitigate premature closure in inexperienced learners, these are rarely studied in experienced physicians. Our objective here was to evaluate the effect of analytic information processing on diagnostic performance of nephrologists and nephrology residents. Methods: We asked nine nephrologists and six nephrology residents at the University of Calgary and Glasgow University to diagnose ten nephrology cases. We provided presenting features along with contextual information, after which we asked for an initial diagnosis. We then primed participants to use either hypothetico-deductive reasoning or scheme-inductive reasoning to analyze the remaining case data and generate a final diagnosis. Results: After analyzing initial hypotheses, both nephrologists and residents improved the accuracy of final diagnoses (31.1% vs. 65.6%, p < 0.001, and 40.0% vs. 70.0%, p < 0.001, respectively). We found a significant interaction between experience and analytic processing strategy ( p = 0.002): nephrology residents had significantly increased odds of diagnostic success when using scheme-inductive reasoning (odds ratio [95% confidence interval] 5.69 [1.59, 20.33], p = 0.007), whereas the performance of experienced nephrologists did not differ between strategies (odds ratio 0.57 [0.23, 1.39], p = 0.2). Discussion: Experienced nephrologists and nephrology residents can improve their performance by analyzing initial diagnostic hypotheses. The explanation of the interaction between experience and the effect of different reasoning strategies is unclear, but may relate to preferences in reasoning strategy, or the changes in knowledge structure with experience.
- Subjects :
- Nephrology
medicine.medical_specialty
Medicine (General)
business.industry
MEDLINE
Metacognition
Cognition
Education (General)
Major Contribution/Research Article
Odds ratio
Bioinformatics
medical error
Confidence interval
Odds
R5-920
Internal medicine
Family medicine
medicine
cognitive processing
analytic processing
General Materials Science
Medical diagnosis
L7-991
business
Subjects
Details
- Language :
- English
- ISSN :
- 19231202
- Volume :
- 4
- Issue :
- 1
- Database :
- OpenAIRE
- Journal :
- Canadian Medical Education Journal
- Accession number :
- edsair.doi.dedup.....efcc4e3ad486c4b5453b891e0c5fbe83