Awareness of Diagnostic Error among Japanese Residents: a Nationwide Study
Awareness of Diagnostic Error among Japanese Residents: a Nationwide Study
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DOI：
10.1007/s11606-017-4248-y
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发表时间：
2018-04-01
影响因子：
5.7
通讯作者：
Tokuda, Yasuharu
中科院分区：
文献类型：
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作者：
Nishizaki, Yuji;Shinozaki, Tomohiro;Tokuda, Yasuharu
不同国家的居民对诊断错误的理解可能不同。我们试图探讨诊断错误知识与自学、临床知识和经验之间的关系。我们的全国性研究涉及研究生一年级和二年级（PGY-1和-2）的日本居民。2014学年结束时进行诊断错误知识评估测试（D-KAT）和全科医学在职考试（GM-ITE）。D-KAT得分与美国居民的基准得分进行了比较。还分析了D-KAT评分与性别、PGY、每月急诊科（ED）轮转、任何给定时间处理的平均住院患者数和平均每日自学分钟数之间的关系，无论是否调整GM-ITE评分。使用学生t检验与线性混合模型和结构方程模型（SEM）进行比较，以探索与D-KAT或GM-ITE分数的关系。日本PGY-2患者的平均D-KAT评分显著低于美国PGY-2患者（6.2比8.3,p < 0.001）。GM-ITE评分与ED轮转数（6轮：2.14;0.16-4.13;p = 0.03）、住院病例数（5-9例：1.79;0.82-2.76;p < 0.001）和平均每日自学分钟数（91分钟：2.05;0.56-3.53;p = 0.01）相关。SEM显示，D-KAT评分与GM-ITE评分直接相关（= 0.37,95% CI: 0.34-0.41），与ED旋转（= 0.06,95% CI: 0.02-0.10）、住院病例量（= 0.04,95% CI: 0.003-0.08）和平均每日学习时间（= 0.13,95% CI: 0.09-0.17）间接相关。与美国居民相比，日本居民对诊断错误的认识较差。D-KAT评分与GM-ITE评分密切相关，GM-ITE评分与更多的ED轮转次数、更大的病例量（尽管最多只有15例患者）和更多的学习时间呈正相关。
Residents' understanding of diagnostic error may differ between countries. We sought to explore the relationship between diagnostic error knowledge and self-study, clinical knowledge, and experience.Our nationwide study involved postgraduate year 1 and 2 (PGY-1 and -2) Japanese residents. The Diagnostic Error Knowledge Assessment Test (D-KAT) and General Medicine In-Training Examination (GM-ITE) were administered at the end of the 2014 academic year. D-KAT scores were compared with the benchmark scores of US residents. Associations between D-KAT score and gender, PGY, emergency department (ED) rotations per month, mean number of inpatients handled at any given time, and mean daily minutes of self-study were also analyzed, both with and without adjusting for GM-ITE scores. Student's t test was used for comparisons with linear mixed models and structural equation models (SEM) to explore associations with D-KAT or GM-ITE scores.The mean D-KAT score among Japanese PGY-2 residents was significantly lower than that of their US PGY-2 counterparts (6.2 vs. 8.3, p < 0.001). GM-ITE scores correlated with ED rotations (6 rotations: 2.14; 0.16-4.13; p = 0.03), inpatient caseloads (5-9 patients: 1.79; 0.82-2.76; p < 0.001), and average daily minutes of self-study (91 min: 2.05; 0.56-3.53; p = 0.01). SEM revealed that D-KAT scores were directly associated with GM-ITE scores ( = 0.37, 95% CI: 0.34-0.41) and indirectly associated with ED rotations ( = 0.06, 95% CI: 0.02-0.10), inpatient caseload ( = 0.04, 95% CI: 0.003-0.08), and average daily minutes of study ( = 0.13, 95% CI: 0.09-0.17).Knowledge regarding diagnostic error among Japanese residents was poor compared with that among US residents. D-KAT scores correlated strongly with GM-ITE scores, and the latter scores were positively associated with a greater number of ED rotations, larger caseload (though only up to 15 patients), and more time spent studying.