Dr. Ho Ping Kong Center for Excellence in Education and Practice, University Health Network-Western Division, 399 Bathurst Street, 8 East 427B, Toronto, ON M5T 2S8, Canada.
Adv Health Sci Educ Theory Pract. 2013 Aug;18(3):497-508. doi: 10.1007/s10459-012-9388-6. Epub 2012 Jun 21.
Use of dual-processing has been widely touted as a strategy to reduce diagnostic error in clinical medicine. However, this strategy has not been tested among medical trainees with complex diagnostic problems. We sought to determine whether dual-processing instruction could reduce diagnostic error across a spectrum of experience with trainees undertaking cardiac physical exam. Three experiments were conducted using a similar design to teach cardiac physical exam using a cardiopulmonary simulator. One experiment was conducted in each of three groups: experienced, intermediate and novice trainees. In all three experiments, participants were randomized to receive undirected or dual-processing verbal instruction during teaching, practice and testing phases. When tested, dual-processing instruction did not change the probability assigned to the correct diagnosis in any of the three experiments. Among intermediates, there was an apparent interaction between the diagnosis tested and the effect of dual-processing instruction. Among relative novices, dual processing instruction may have dampened the harmful effect of a bias away from the correct diagnosis. Further work is needed to define the role of dual-processing instruction to reduce cognitive error. This study suggests that it cannot be blindly applied to complex diagnostic problems such as cardiac physical exam.
双加工策略被广泛认为是减少临床医学诊断错误的一种策略。然而，这种策略尚未在面临复杂诊断问题的医学受训者中进行测试。我们旨在确定双加工指导是否可以减少受训者在进行心脏体格检查时从经验丰富到经验不足的一系列过程中的诊断错误。使用心肺模拟器，采用类似的设计进行了三项实验，以教授心脏体格检查。在每个实验中，参与者被随机分配在教学、练习和测试阶段接受非指导性或双加工口头指导。在所有三个实验中，双加工指导都没有改变测试中正确诊断的概率。在中等经验者中，所测试的诊断与双加工指导效果之间存在明显的相互作用。在相对新手中，双加工指导可能减轻了远离正确诊断的偏差的有害影响。需要进一步的工作来确定双加工指导在减少认知错误方面的作用。本研究表明，它不能盲目应用于心脏体格检查等复杂的诊断问题。
