Measuring residents' performance of diagnostic reasoning using clinical vignettes: an international collaborative study

使用临床小插图衡量居民诊断推理的表现：一项国际合作研究

• 批准号: 17590461
• 负责人: NOGUCHI Yoshinori
• 金额: $ 2.11万
• 依托单位: Kyoto University (2006)Fujita Health University (2005)
• 依托单位国家: 日本
• 项目类别: Grant-in-Aid for Scientific Research (C)
• 财政年份: 2005
• 资助国家: 日本
• 起止时间: 2005 至 2006
• 项目状态: 已结题
• 来源: https://kaken.nii.ac.jp/en/grant/KAKENHI-PROJECT-17590461/
• 关键词: Diagnostic reasoning; Hypotheco-deductive method; Pre-test probability; Post-test probability; International comparison; 医学教育

OBJECTIVE : To compare the diagnostic thinking process of medical students in Japan and US.METHODS : Students were presented with three clinical scenarios corresponding to high, low, and intermediate pre-test probability of coronary artery disease. Estimates of pre-test and post-test probability for each scenario were elicited from the students (intuitive estimates) and from the literature (reference estimates). The difference between the reference estimates and the intuitive estimates was used for assessing knowledge of test characteristics, ability of estimating pre-test and post-test probability of disease.RESULTS : One hundred twelve students in US and 224 in Japan were participated. Both US and Japanese students underestimated pre-test and post-test probability of high pre-test scenario, although the estimates are close to reference estimates. There was no significant difference between US and Japan. In the low pre-test probability scenario, both students overestimated the pre-test and post-test probability. The deviation from reference estimate was, however, greater in Japanese students.CONCLUSIONS : US and Japanese students could not rule out disease in low or intermediate pre-test probability settings, mainly because of poor pre-test estimates of disease probability. But, US students performed significantly accurate estimation than Japanese students. This diagnostic thinking pattern account for why medical students or novice physicians end up repeating unnecessary examinations.In medical education in Japan, ruling out disease has been less emphasized than the importance of not overlooking a possible disease. It is presumed that this traditional attitude is associated with the difference in the diagnostic thinking process between US and Japanese medical students.

目的：比较日本和美国医学生的诊断思维过程。方法：向学生呈现三种临床情景，分别对应于冠状动脉疾病的高、低和中等预试概率。每种情景的测试前和测试后概率的估计是从学生(直观估计)和文献(参考估计)得出的。结果：美国学生112人，日本学生224人，他们对考试特点的了解程度、考试前和考试后患病概率的估计能力。美国和日本学生都低估了高考前情景的考试前和考试后的概率，尽管估计接近参考估计。美国和日本之间无显著差异。在低考前概率情景中，两名学生都高估了考前概率和考后概率。结论：美国和日本学生在低或中等测试前概率环境下不能排除疾病，主要是因为对疾病概率的测试前估计较差。但是，美国学生的估计比日本学生准确得多。这种诊断性思维模式解释了为什么医科学生或新手医生最终会重复不必要的检查。在日本的医学教育中，与其说强调排除疾病，不如说强调不要忽视可能的疾病。据推测，这种传统态度与美国和日本医学生在诊断思维过程上的差异有关。