Instructional Methods Clinical Trial
Official title:
A Study to Evaluate Strategies for Teaching Effective Use of Diagnostic Tests
A recent Institute of Medicine monograph brought attention to high rates of diagnostic error and called for better educational efforts to improve diagnostic accuracy.1 Educational methods, however, are rarely tested and some educational efforts may be ineffective and wasteful.2 In this study, we plan to examine whether explicit instruction on diagnostic methods will have an effect on diagnostic accuracy of 2nd-year medical students and internal medicine residents.
Research has shown that expert diagnosticians use a two-step process to confirm a diagnosis:
hypothesis generation to generate diagnostic possibilities, followed by hypothesis
verification to confirm the most likely diagnostic possibility.3-5 The first step appears to
be non-analytical, related to pattern recognition. The second step could be calculated using
analytical reasoning, however, physicians rarely make an overt calculation of conditional
probabilities. Instead, experienced clinicians typically use an implicit habit or heuristic
called "anchoring and adjusting" to incorporate diagnostic testing information into their
thinking.6,7 Cognitive psychologists have postulated that anchoring and adjusting provides a
way that probability estimates can be updated based on additional new evidence. Most of the
discussion in the literature focuses on how this heuristic can lead to biased thinking
because of base-rate neglect or anchoring.6 Very little discussion is on how this heuristic
could be improved to yield more accurate probability estimates and whether proper use of the
heuristic could be taught.
The degree to which a diagnostic test should lead to an adjustment of a probability estimate
depends on the operating characteristics of a test, that is, the sensitivity and specificity.
Likelihood ratios, once understood, are easier to incorporate into one's thinking, and thus
could be used to calibrate the anchoring and adjusting heuristic.7
In this randomized trial, we tested whether explicit conceptual instruction on Bayesian
reasoning and likelihood ratios would improve Bayesian updating, compared with a second
intervention where we provided multiple (27) examples of clinical problem solving. The third
arm provided minimal teaching about diagnosis, but no explicit teaching or examples.
;
| Status | Clinical Trial | Phase | |
|---|---|---|---|
| Completed |
NCT06426095 -
A Comparative Analysis of the Efficacy of Instructional Videos and Live Demonstrations in Crown Preparation Training for Preclinical Dental Students
|
N/A |