Nerima Hikarigaoka Hospital, Japan.
Med Teach. 2013 Jun;35(6):e1218-29. doi: 10.3109/0142159X.2012.742493. Epub 2012 Dec 11.
How clinicians conduct diagnostic reasoning is a major issue.
To evaluate whether intuitive and analytic processes (differential diagnosis checklist, DDXC; general de-biasing checklist, GDBC) might improve diagnostic performance.
We enrolled 188 medical students (4th-6th grades) who were divided into two groups and assigned the five cases scenarios. Group 1 (n = 91) were instructed to provide the three most likely diagnoses immediately after reading the scenarios (intuitive diagnosis), then after reading GDBC (diagnosis by GDBC), and finally, after reading DDXC (diagnosis by DDXC). Conversely, group 2 (n = 97) were instructed to provide intuitive diagnoses, by DDXC, and by GDBC.
Among the group 1, there was significant difference of total scores (p = 0.01 by ANOVA) between intuitive (8.25) and DDXC (8.77). Among the group 2, we noted significant difference of total scores (p = 0.001 by ANOVA) between intuitive (7.21) and DDXC (7.96). Among the difficult cases, the proportions of correct diagnosis increased after reading DDXC, although among the simple cases, the proportions of correct diagnosis decreased after reading DDXC.
The use of DDXC, not GDBC, may improve the diagnostic performance in difficult cases, while intuitive process may still be better for simpler cases.
临床医生如何进行诊断推理是一个主要问题。
评估直觉和分析过程（鉴别诊断检查表，DDXC；一般去偏倚检查表，GDBC）是否可能提高诊断性能。
我们招募了 188 名医学生（4-6 年级），将他们分为两组，并分配了五个案例场景。第 1 组（n=91）被指示在阅读完案例后立即提供三个最可能的诊断（直觉诊断），然后在阅读 GDBC（基于 GDBC 的诊断）后，最后在阅读 DDXC（基于 DDXC 的诊断）后。相反，第 2 组（n=97）被指示提供直觉诊断、基于 DDXC 的诊断和基于 GDBC 的诊断。
在第 1 组中，直觉（8.25）和 DDXC（8.77）之间的总分存在显著差异（ANOVA 检验，p=0.01）。在第 2 组中，我们注意到直觉（7.21）和 DDXC（7.96）之间的总分存在显著差异（ANOVA 检验，p=0.001）。在困难案例中，阅读 DDXC 后正确诊断的比例增加，尽管在简单案例中，阅读 DDXC 后正确诊断的比例下降。
使用 DDXC，而不是 GDBC，可能会提高困难案例的诊断性能，而直觉过程可能仍然更适合简单案例。
