Hatala R, Norman G R, Brooks L R
Department of Medicine, McMaster University, Hamilton, Ont, Canada.
J Gen Intern Med. 1999 Feb;14(2):126-9. doi: 10.1046/j.1525-1497.1999.00298.x.
To examine the effect of clinical history on the electrocardiogram (ECG) interpretation skills of physicians with different levels of expertise, we randomly allocated to an ECG test package 30 final-year medical students, 15 second-year internal medicine residents, and 15 university cardiologists at university-affiliated teaching hospitals. All participants interpreted the same set of 10 ECGs. Each ECG was accompanied by a brief clinical history suggestive of the correct ECG diagnosis, or the most plausible alternative diagnosis, or no history. Provision of a correct history improved accuracy by 4% to 12% compared with no history, depending on level of training. Conversely, a misleading history compared with no history reduced accuracy by 5% for cardiologists, 25% for residents, and 19% for students. Clinical history also affected the participants' frequencies of listing ECG features consistent with the correct diagnosis and features consistent with the alternative diagnosis (all p values < .05). For physicians at all levels of expertise, clinical history has an influence on ECG diagnostic accuracy, both improving accuracy when the history suggests the correct diagnosis, and reducing accuracy when the history suggests an alternative diagnosis.
为了研究临床病史对不同专业水平医生心电图（ECG）解读技能的影响，我们将30名医学专业最后一年的学生、15名内科二年级住院医师以及15名大学附属医院的心脏病专家随机分配至一个心电图测试包。所有参与者解读同一组10份心电图。每份心电图都附有一段简短的临床病史，提示正确的心电图诊断、最合理的替代诊断或无病史。与无病史相比，提供正确病史可使准确率提高4%至12%，具体取决于培训水平。相反，与无病史相比，误导性病史会使心脏病专家的准确率降低5%，住院医师降低25%，学生降低19%。临床病史还影响了参与者列出与正确诊断一致的心电图特征以及与替代诊断一致的特征（所有p值<0.05）的频率。对于所有专业水平的医生，临床病史都会影响心电图诊断准确性，当病史提示正确诊断时提高准确性，当病史提示替代诊断时降低准确性。
