Nendaz M
Service de médecine interne générale, UDREM, hôpitaux universitaires, 1211 Genève 14, Suisse.
Rev Med Interne. 2011 Jul;32(7):436-42. doi: 10.1016/j.revmed.2010.12.005. Epub 2011 Jan 12.
A medical decision when facing a clinical problem is the result of a complex process involving clinical reasoning and decision-making components. Several biases and external factors may influence this process. Educational interventions may be helpful to modify some of those factors and enhance the quality of decision-making, such as the training of clinical reasoning, making physicians aware of potential biases, or training them to use some tools brought by the evidence-based medicine movement. However, the impact of such interventions remains difficult to quantify because high-quality data are lacking and few studies really assess patient outcomes. This article reviews the available evidence of interventions aiming at improving the quality of decision-making and stresses the importance of involving clinician teachers in medical education research.
面对临床问题时做出的医学决策是一个复杂过程的结果,该过程涉及临床推理和决策要素。若干偏差和外部因素可能会影响这一过程。教育干预措施可能有助于改变其中一些因素并提高决策质量,比如临床推理培训、让医生意识到潜在偏差,或培训他们使用循证医学运动带来的一些工具。然而,此类干预措施的影响仍难以量化,因为缺乏高质量数据,而且很少有研究真正评估患者的治疗结果。本文综述了旨在提高决策质量的干预措施的现有证据,并强调临床教师参与医学教育研究的重要性。