Diagnostic Error
Conditions
Keywords
medical simulation, diagnostic error, pulmonary embolism
Brief summary
This prospective randomized simulator-based single-blind trial aimed to investigate the effects of initial cues and history taking skills on diagnostic accuracy
Detailed description
Diagnostic errors are a relevant health-care problem. As medical history taking is usually the first step in a patient's assessment its quality is most likely a first and important barrier against diagnostic errors. There are, however, only limited data on the association of the quality of medical history taking and diagnostic accuracy.This prospective randomized simulator-based single-blind trial aimed to investigate the effects of initial cues and history taking skills on diagnostic accuracy. 198 medical students (135 females) were given the task to assess a patient presenting with simulated acute pulmonary embolism. Participants were randomized to six versions of the scenario differing only in the initial cues, i.e. in the reply of the patient to the initial question about the reason for his visit. In three of six versions, initial cues were restricted to thoracic symptoms (chest pain, dyspnoea, or combination of both). In the remaining three versions, initial cues consisted of thoracic and extra-thoracic (leg pain, immobilization) symptoms. The primary outcome was diagnostic accuracy. The mannequin was equipped with a speaker in its head that broadcasts the voice of a remote operator (experienced physician) allowing verbal interaction of the participants with the patient. The patient did not speak unless asked and responded to all participants' questions during history taking according to a pre-defined checklist.
Interventions
OTHERInitial cue
Symptom volunteered by the patient
Sponsors
University Hospital, Basel, Switzerland
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
DIAGNOSTIC
Masking
SINGLE (Subject)
Masking description
Single-blind trial; participants not aware of the goal of the study
Intervention model description
Participants were randomized (computer-generated numbers) to six versions of a simulated scenario of pulmonary embolism. The six versions differed only in the initial cues, i.e. in the reply of the patient to the initial question about the reason for his visit.
Eligibility
Sex/Gender
ALL
Age
20 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* 4th year medical students participating in voluntary simulator-based workshops
Exclusion criteria
* decline to give written informed consent
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Stating the correct diagnosis | 5 minutes | At the end of the study time (5 minutes), a study physician enters the simulator room and asks the participate on his/her presumptive diagnosis. Simualtions are video-taped and the analysis of the outcome is performed by trained observers by video analysis. Stating the correct diagnosis is a binary outcome, rated either as yes (correct presumptive diagnosis of pulmonary embolism is stated) or no (correct presumptive diagnosis of pulmonary embolism is NOT stated). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Depth of history taking | 5 minutes | Data analysis is performed using video-recordings recorded during scenarios. Trained observers note kind and timing of all questions. Questions were categorized in six pre-defined categories (chest pain, dyspnoea,associated symptoms, risk factors for pulmonary embolism,cardiovascular risk factors, personal history). Depth of information gathering is assessed for each category separately and is defined as the total number of questions asked in any given category. |
| Breadth of history taking | 5 minutes | Data analysis is performed using video-recordings recorded during scenarios. Trained observers note kind and timing of all questions. The three problem areas chest pain, dyspnea, and leg pain or leg swelling were defined à priori as relevant. Breadth of information gathering is defined as number of relevant problem areas identified (possible range from 0 to 3). |
| Systematics of history taking | 5 minutes | Data analysis is performed using video-recordings recorded during scenarios. Trained observers note kind and timing of all questions. Questions were categorized in six pre-defined categories (chest pain, dyspnoea,associated symptoms, risk factors for pulmonary embolism,cardiovascular risk factors, personal history). All questions will be rated as either systematic question or non-systematic question. A systematic questions is defined as question, that is either immediately preceded or immediately followed by a question of the same category. Systematic questions will be expressed as percentage of all questions asked during history taking (possible range 0% to 100%) |
Countries
Switzerland
Outcome results
None listed