目标已显示诊断推理受先前类似患者病例的影响。然而,目前尚不清楚这一过程是否会影响诊断错误率,或者所有经验水平的临床医生是否同样容易受到影响.本研究测量了特定的先前暴露和经验水平对诊断准确性的影响。方法创造先前暴露的经验,参与者(实习前医学生,急诊医学居民,和教职员工)首先验证了临床小插曲的诊断。使用等可能的临床小插曲来测量先前暴露的影响;指示两个诊断。参与者诊断出同等可能的病例:1)与暴露病例相匹配(在三种情况之一中:a)相似的患者特征,相似的临床特征;b)不同的患者特征,相似的临床特征;c)相似的患者特征,不同的临床特征),或2)与任何先前的情况(d)没有暴露相匹配)。与匹配的暴露病例一致的诊断评分正确。以前没有接触过的病例没有匹配的病例,因此验证了等概率设计。结果诊断A占条件d的反应的47%,但患者特征的特异性相似性对诊断A没有影响,F(3,712)=7.28,p=0.28或诊断B,F(3,712)=4.87,p=0.19。当根据两个等概率诊断的匹配进行重新评分时,精度高,但受惠教师(n=40)98%,居民(n=39)98%,医学生(n=32)85%,F(2,712)=35.6,p<0.0001。医学生的准确率分别为84%,87%,94%和73%,分别,相互作用F(2,712)=3.55,p<0.002。结论实习前医学生的鉴别诊断随着既往暴露而提高,但这与具体病例或患者特征无关.医疗住院医师和工作人员的准确性不受先前暴露的影响。
Objectives Diagnostic reasoning has been shown to be influenced by a prior similar patient case. However, it is unclear whether this process influences diagnostic error rates or whether clinicians at all experience levels are equally susceptible. The present study measured the influence of specific prior exposure and experience level on diagnostic accuracy. Methods To create the experience of prior exposure, participants (pre-clerkship medical students, emergency medicine residents, and faculty) first verified diagnoses of clinical vignettes. The influence of prior exposures was measured using equiprobable clinical vignettes; indicating two diagnoses. Participants diagnosed equiprobable cases that were: 1) matched to exposure cases (in one of three conditions: a) similar patient features, similar clinical features; b) dissimilar patient features, similar clinical features; c) similar patient features, dissimilar clinical features), or 2) not matched to any prior case (d) no exposure). A diagnosis consistent with a matched exposure case was scored correct. Cases with no prior exposure had no matched cases, hence validated the equiprobable design. Results Diagnosis A represented 47% of responses in condition d, but there was no influence of specific similarity of patient characteristics for Diagnosis A, F(3,712)=7.28, p=0.28 or Diagnosis B, F(3,712)=4.87, p=0.19. When re-scored based on matching both equiprobable diagnoses, accuracy was high, but favored faculty (n=40) 98%, and residents (n=39) 98% over medical students (n=32) 85%, F(2,712)=35.6, p<0.0001. Accuracy for medical students was 84, 87, 94, and 73% for conditions a-d, respectively, interaction F(2,712)=3.55, p<0.002. Conclusions The differential diagnosis of pre-clerkship medical students improved with prior exposure, but this was unrelated to specific case or patient features. The accuracy of medical residents and staff was not influenced by prior exposure.