Lambe Kathryn Ann, O'Reilly Gary, Kelly Brendan D, Curristan Sarah
School of Psychology, Trinity College Dublin, Dublin, Ireland.
School of Psychology, University College Dublin, Dublin, Ireland.
BMJ Qual Saf. 2016 Oct;25(10):808-20. doi: 10.1136/bmjqs-2015-004417. Epub 2016 Feb 12.
Diagnostic error incurs enormous human and economic costs. The dual-process model reasoning provides a framework for understanding the diagnostic process and attributes certain errors to faulty cognitive shortcuts (heuristics). The literature contains many suggestions to counteract these and to enhance analytical and non-analytical modes of reasoning.
To identify, describe and appraise studies that have empirically investigated interventions to enhance analytical and non-analytical reasoning among medical trainees and doctors, and to assess their effectiveness.
Systematic searches of five databases were carried out (Medline, PsycInfo, Embase, Education Resource Information Centre (ERIC) and Cochrane Database of Controlled Trials), supplemented with searches of bibliographies and relevant journals. Included studies evaluated an intervention to enhance analytical and/or non-analytical reasoning among medical trainees or doctors.
Twenty-eight studies were included under five categories: educational interventions, checklists, cognitive forcing strategies, guided reflection, instructions at test and other interventions. While many of the studies found some effect of interventions, guided reflection interventions emerged as the most consistently successful across five studies, and cognitive forcing strategies improved accuracy and confidence judgements. Significant heterogeneity of measurement approaches was observed, and existing studies are largely limited to early-career doctors.
Results to date are promising and this relatively young field is now close to a point where these kinds of cognitive interventions can be recommended to educators. Further research with refined methodology and more diverse samples is required before firm recommendations may be made for medical education and policy; however, these results suggest that such interventions hold promise, with much current enthusiasm for new research.
诊断错误会带来巨大的人力和经济成本。双加工模型推理为理解诊断过程提供了一个框架，并将某些错误归因于有缺陷的认知捷径（启发法）。文献中有许多建议来对抗这些问题，并增强分析性和非分析性推理模式。
识别、描述和评估那些实证研究过旨在增强医学实习生和医生的分析性和非分析性推理的干预措施的研究，并评估其有效性。
对五个数据库（医学索引数据库、心理学文摘数据库、荷兰医学文摘数据库、教育资源信息中心数据库和考科蓝对照试验数据库）进行了系统检索，并辅以参考文献和相关期刊的检索。纳入的研究评估了一项旨在增强医学实习生或医生的分析性和/或非分析性推理的干预措施。
28项研究被归入五个类别：教育干预、检查表、认知强制策略、引导式反思、考试指导及其他干预措施。虽然许多研究发现干预措施有一定效果，但引导式反思干预措施在五项研究中表现出最为一致的成功，认知强制策略提高了准确性和信心判断。观察到测量方法存在显著异质性，现有研究大多局限于初出茅庐的医生。
迄今为止的结果很有前景，这个相对年轻的领域现在已接近可以向教育工作者推荐这类认知干预措施的阶段。在能够为医学教育和政策提出确凿建议之前，需要采用更完善的方法和更具多样性的样本进行进一步研究；然而，这些结果表明此类干预措施很有前景，目前人们对新研究充满热情。
