干扰诊断推理：打断、指令和经验会影响住院医师和急诊医师的诊断准确性及反应时间吗？

Disrupting diagnostic reasoning: do interruptions, instructions, and experience affect the diagnostic accuracy and response time of residents and emergency physicians?

作者信息

Monteiro Sandra D, Sherbino Jonathan David, Ilgen Jonathan Seth, Dore Kelly L, Wood Timothy J, Young Meredith E, Bandiera Glen, Blouin Danielle, Gaissmaier Wolfgang, Norman Geoffrey R, Howey Elizabeth

机构信息

Dr. Monteiro is assistant professor, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada. Dr. Sherbino is associate professor, Department of Medicine, McMaster University, Hamilton, Ontario, Canada. Dr. Ilgen is assistant professor, Division of Emergency Medicine, School of Medicine, University of Washington, Seattle, Washington. Dr. Dore is assistant professor, Department of Medicine, McMaster University, Hamilton, Ontario, Canada. Dr. Wood is associate professor, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada. Dr. Young is assistant professor, Department of Medicine, McGill University, Montreal, Quebec, Canada. Dr. Bandiera is director of postgraduate programs, Department of Medicine and Postgraduate Medical Education, University of Toronto, Toronto, Ontario, Canada. Dr. Blouin is director of faculty development for health sciences, Department of Emergency Medicine, Queen's University, Kingston, Ontario, Canada. Dr. Gaissmaier is professor, Department of Psychology, University of Konstanz, Konstanz, Germany. Dr. Norman is professor, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada. Ms. Howey is a research associate, Program for Educational Research and Development, McMaster University, Hamilton, Ontario, Canada.

出版信息

Acad Med. 2015 Apr;90(4):511-7. doi: 10.1097/ACM.0000000000000614.

DOI:10.1097/ACM.0000000000000614

PMID:25565260

Abstract

PURPOSE

Others have suggested that increased time pressure, sometimes caused by interruptions, may result in increased diagnostic errors. The authors previously found, however, that increased time pressure alone does not result in increased errors, but they did not test the effect of interruptions. It is unclear whether experience modulates the combined effects of time pressure and interruptions. This study investigated whether increased time pressure, interruptions, and experience level affect diagnostic accuracy and response time.

METHOD

In October 2012, 152 residents were recruited at five Medical Council of Canada Qualifying Examination Part II test sites. Forty-six emergency physicians were recruited from one Canadian and one U.S. academic health center. Participants diagnosed 20 written general medicine cases. They were randomly assigned to receive fast (time pressure) or slow condition instructions. Visual and auditory case interruptions were manipulated as a within-subject factor.

RESULTS

Diagnostic accuracy was not affected by interruptions or time pressure but was related to experience level: Emergency physicians were more accurate (71%) than residents (43%) (F = 234.0, P < .0001) and responded more quickly (54 seconds) than residents (65 seconds) (F = 9.0, P < .005). Response time was shorter for participants in the fast condition (55 seconds) than in the slow condition (73 seconds) (F = 22.2, P < .0001). Interruptions added about 8 seconds to response time.

CONCLUSIONS

Experienced emergency physicians were both faster and more accurate than residents. Instructions to proceed quickly and interruptions had a small effect on response time but no effect on accuracy.

摘要

目的

其他人曾提出，有时由干扰导致的时间压力增加可能会导致诊断错误增加。然而，作者之前发现，仅时间压力增加并不会导致错误增加，但他们并未测试干扰的影响。目前尚不清楚经验是否会调节时间压力和干扰的综合影响。本研究调查了时间压力增加、干扰和经验水平是否会影响诊断准确性和反应时间。

方法

2012年10月，在加拿大医学委员会资格考试第二部分的五个考试地点招募了152名住院医师。从一家加拿大和一家美国学术健康中心招募了46名急诊医生。参与者诊断20例书面普通内科病例。他们被随机分配接受快速（时间压力）或慢速条件的指导。视觉和听觉病例干扰作为一个受试者内因素进行操纵。

结果

诊断准确性不受干扰或时间压力的影响，但与经验水平有关：急诊医生比住院医师更准确（71%）（43%）（F = 234.0，P < .0001），并且比住院医师反应更快（54秒）（65秒）（F = 9.0，P < .005）。快速条件下的参与者反应时间（55秒）比慢速条件下（73秒）短（F = 22.2，P < .0001）。干扰使反应时间增加了约8秒。