The effect of prior experience on diagnostic reasoning: exploration of availability bias
Author:
Monteiro Sandra12ORCID, Sherbino Jonathan23, Ilgen Jonathan S.45, Hayden Emily M.6, Howey Elizabeth2, Norman Geoff12
Affiliation:
1. Department of Health Research Methods, Evidence and Impact , McMaster University , Hamilton , ON , Canada 2. McMaster Faculty of Health Sciences Education Research, Innovation and Theory (MERIT) Program , McMaster University , Hamilton , ON , Canada 3. Division of Emergency Medicine, Department of Medicine , McMaster University , Hamilton , ON , Canada 4. Department of Emergency Medicine , University of Washington , Seattle , WA , USA 5. Center for Leadership & Innovation in Medical Education , University of Washington , Seattle , WA , USA 6. Department of Emergency Medicine , Massachusetts General Hospital , Boston , MA , USA
Abstract
Abstract
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.
Funder
Royal College of Physicians and Surgeons of Canada
Publisher
Walter de Gruyter GmbH
Subject
Biochemistry (medical),Clinical Biochemistry,Public Health, Environmental and Occupational Health,Health Policy,Medicine (miscellaneous)
Reference33 articles.
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