Diagnostic accuracy in Family Medicine residents using a clinical decision support system (DXplain): a randomized-controlled trial (original) (raw)
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Effects of a Decision Support System on Physicians' Diagnostic Performance
Journal of the American Medical Informatics Association, 1999
This study examines how the information provided by a diagnostic decision support system for clinical cases of varying diagnostic difficulty affects physicians' diagnostic performance. Methods: A national sample of 67 internists, 35 family physicians, and 6 other physicians used the Quick Medical Reference (QMR) diagnostic decision support system to assist them in the diagnosis of written clinical cases. Three sets of eight cases, stratified by diagnostic difficulty and the potential of QMR to produce high-quality information, were used. The effects of using QMR on three measures of physicians' diagnostic performance were analyzed using analyses of variance. Results: Physicians' diagnostic performance was significantly higher (p < 0.01) on the easier cases and the cases for which QMR could provide higher-quality information. Conclusions: Physicians' diagnostic performance can be strongly influenced by the quality of information the system produces and the type of cases on which the system is used.
AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium, 2003
Clinical decision support systems (CDSS) can impact both diagnostic and therapeutic decision-making, but physicians sometimes fail to heed the appropriate CDSS advice, or become influenced in a negative way by the CDSS. This study examined the relationships among clinicians' prior diagnostic accuracy, the performance of a diagnostic CDSS, and how the CDSS influenced the accuracy of the clinician's subsequent diagnoses. Results showed that (1) clinicians who already were considering the correct diagnosis prior to using the CDSS were more likely to get the CDSS to produce the correct diagnosis in a prominent position than those not considering it initially; (2) physicians are strongly anchored by their initial diagnoses prior to using the CDSS; and (3) changes in the clinicians' diagnoses after using the CDSS are related to presence or absence of the correct diagnosis in the top 10 diagnoses displayed by the CDSS.
Proceedings a Conference of the American Medical Informatics Association Amia Annual Fall Symposium Amia Fall Symposium, 1996
As conmputer-based diagnostic consultation systems becomtie available, their inifluetnce cmd usefultness need to be evaluated. This report, based on partial cka front a larger studs, exanmines the influenice of Iliad, a diagnostic cotisultation system, oni the differential diagntosis qffourth yearniedical studenits, residents in medicine, and attendinigs int genieral ititernal niedicinie. Our results show that wvhetn faced with difficult diagntostic cases, niedical studenits add sigtnficanitli more diagnoses fronm Iliad's differential thati dk residents or attendings. Hovvever, the quality of Iliad's diagnostic advice inl terimis of the presenice of the correct diagnosis, is no better for cotisultations done b) students or residents compared to attendings.
Proceedings / AMIA ... Annual Symposium. AMIA Symposium, 2002
The objective of this study was to determine whether Internal Medicine residents would find the use of an expert system (i.e. Clinical Diagnostic Decision Support System) to be a satisfactory experience when used during a clinical rotation in the hospital setting. Resident willingness to use the instrument was considered to be of particular importance because of growing concerns regarding the educational experience of residents in the hospital. Thus, our first goal was to assess resident satisfaction with the tool, prior to widespread implementation. Residents on the General Medical Hospital Service at St. Mary's Hospital, Rochester, Minnesota Prospective cohort study We provided unrestricted access DXplain, a Web-based Clinical Diagnostic Decision Support System, to five general medical teams in St. Mary's Hospital, Rochester, MN. All residents were particularly encouraged to access the system during the evaluation of new admissions. Usage of the system was recorded electro...
Diagnosis, 2018
Background: Clinical reasoning is an essential skill in physicians, required to address the challenges of accurate patient diagnoses. The goal of the study was to compare the diagnostic accuracy in Family Medicine residents, with and without the use of a clinical decision support tool (DXplain http://www.mghlcs.org/projects/dxplain). Methods: A total of 87 first-year Family Medicine residents, training at the National Autonomous University of Mexico (UNAM) Postgraduate Studies Division in Mexico City, participated voluntarily in the study. They were randomized to a control group and an intervention group that used DXplain. Both groups solved 30 clinical diagnosis cases (internal medicine, pediatrics, gynecology and emergency medicine) in a multiple-choice question test that had validity evidence. Results: The percent-correct score in the Diagnosis Test in the control group (44 residents) was 74.1 ± 9.4 (mean ± standard deviation) whereas the DXplain intervention group (43 residents) had a score of 82.4 ± 8.5 (p < 0.001). There were significant differences in the four knowledge content areas of the test. Conclusions: Family Medicine residents have appropriate diagnostic accuracy that can improve with the use of DXplain. This could help decrease diagnostic errors, improve patient safety and the quality of medical practice. The use of clinical decision support systems could be useful in educational interventions and medical practice.
Proceedings : a conference of the American Medical Informatics Association / ... AMIA Annual Fall Symposium. AMIA Fall Symposium, 1997
We examined the degree to which attending physicians, residents, and medical students' stated desire for a consultation on difficult-to-diagnose patient cases is related to changes in their diagnostic judgments after a computer consultation, and whether, in fact, their perceptions of the usefulness of these consultations are related to these changes. The decision support system (DSS) used in this study was ILIAD (v4.2). Preliminary findings based on 16 subjects' (6 general internists, 4 second-year residents in internal medicine, and 6 fourth-year medical students) workup of 136 patient cases indicated no significant main effects for 1) level of experience, 2) whether or not subjects indicated they would seek a diagnostic consultation before using the DSS, or 3) whether or not they found the DSS consultation in fact to be helpful in arriving at a diagnosis (p > .49 in all instances). Nor were there any significant interactions. Findings were similar using subjects or case...
Medical decision making : an international journal of the Society for Medical Decision Making
To investigate the role of information gathering and clinical experience on the diagnosis and management of difficult diagnostic problems in family medicine. Seven diagnostic scenarios including 1 to 4 predetermined features of difficulty were constructed and presented on a computer to 84 physicians: 21 residents in family medicine, 21 family physicians with 1 to 3 y in practice, and 42 family physicians with >or=10 y in practice. Following the Active Information Search process tracing approach, participants were initially presented with a patient description and presenting complaint and were subsequently able to request further information to diagnose and manage the patient. Evidence-based scoring criteria for information gathering, diagnosis, and management were derived from the literature and a separate study of expert opinion. Rates of misdiagnosis were in accordance with the number of features of difficulty. Seventy-eight percent of incorrect diagnoses were followed by inapp...