Lerner Brian S, Kalish Virginia, Ledford Christy J W
National Capital Consortium-Family Medicine Residency, Ft. Belvoir Community Hospital.
Fam Med. 2017 Jun;49(6):460-463.
The diagnosis of dementia is a challenge for physicians due to numerous interrelated barriers. Research shows that this difficulty may be rooted in an incomplete knowledge about dementia. To address this gap, we developed an assessment scale of resident confidence in the diagnosis of dementia and used it to compare resident confidence to their practical ability to diagnose dementia.
The study used a piloted confidence assessment tool for diagnosing dementia correlated with family medicine residents (n=45) performance during an objective structured clinical examination (OSCE). Residents were evaluated during the OSCE for thoroughness of evaluation and patient-centeredness. Following the OSCE, they completed knowledge and diagnostic questionnaires and the confidence assessment tool.
Residents with more years of training performed a more thorough exam and were more confident in their ability to diagnose dementia. However, residents who missed the diagnosis were no less confident in their ability than residents who correctly diagnosed dementia.
Using confidence as a self-assessment may be an inaccurate representation of resident knowledge and ability to diagnose dementia.
由于存在众多相互关联的障碍，痴呆症的诊断对医生来说是一项挑战。研究表明，这一困难可能源于对痴呆症的认识不完整。为了填补这一空白，我们开发了一种住院医师对痴呆症诊断的信心评估量表，并使用它来比较住院医师的信心与其诊断痴呆症的实际能力。
该研究使用了一种经过试点的痴呆症诊断信心评估工具，该工具与家庭医学住院医师（n = 45）在客观结构化临床考试（OSCE）期间的表现相关。在OSCE期间对住院医师进行评估，以评估其评估的彻底性和以患者为中心的程度。OSCE结束后，他们完成了知识和诊断问卷以及信心评估工具。
接受培训年限较长的住院医师进行的检查更彻底，并且对自己诊断痴呆症的能力更有信心。然而，漏诊的住院医师对自己能力的信心并不低于正确诊断痴呆症的住院医师。
将信心作为自我评估可能无法准确反映住院医师诊断痴呆症的知识和能力。
