刻意反思对皮肤科诊断准确性、信心和诊断校准的影响。

Effects of deliberate reflection on diagnostic accuracy, confidence and diagnostic calibration in dermatology.

机构信息

Universidade José do Rosário Vellano, Belo Horizonte, Brazil.

Institute of Medical Education Research Rotterdam, Erasmus MC, University Medical Center Rotterdam, and Department of Psychology, Erasmus University Rotterdam, Rotterdam, The Netherlands.

出版信息

Perspect Med Educ. 2019 Aug;8(4):230-236. doi: 10.1007/s40037-019-0522-5.

DOI:10.1007/s40037-019-0522-5

PMID:31290117

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6684533/

Abstract

BACKGROUND

Deliberate reflection on initial diagnoses improved diagnostic accuracy in internal medicine and general practice, but it is unknown if the same occurs in specialties that rely mostly on visual perception, such as dermatology. Moreover, whether reflection influences diagnostic calibration has not been studied yet. Diagnostic calibration, the relationship between diagnostic accuracy and confidence in that accuracy, affects diagnostic performance because overconfidence tends to induce premature closure. This study evaluated the effects of deliberate reflection on diagnostic accuracy and diagnostic calibration in dermatology.

METHODS

Sixty-one sixth-year students from a Brazilian medical school were allocated to either a reflection group (RG) or a control group (CG). In both groups, students worked with the same 12 dermatological images, presented sequentially, providing an initial diagnosis and confidence in that diagnosis. Subsequently, RG students reflected on the case using a structured procedure, while CG students performed a time-filler activity. All students then provided a final diagnosis and confidence in that diagnosis. Outcome measurements were diagnostic accuracy, confidence, and calibration.

RESULTS

Reflection increased diagnostic accuracy relative to control (49.7 ± 12.1 vs 38.4 ± 14.6; p = 0.002) but did not affect confidence (64.3 ± 13.2 vs 58.9 ± 20.1; p = 0.228) nor calibration (0.15 ± 0.16 vs 0.20 ± 0.19, p = 0.197). Overall, case difficulty influenced calibration, with students showing more overconfidence on more difficult cases (p <0.001).

CONCLUSIONS

Deliberate reflection increased diagnostic accuracy in dermatology but did not affect confidence and calibration. Calibration was worse on more difficult cases, suggesting that calibration is a knowledge-related phenomenon.

摘要

背景

在內科和普通科，对初始诊断进行深思熟虑的反思可以提高诊断准确性，但在依赖视觉感知的专业中，如皮肤科，是否也会出现同样的情况尚不清楚。此外，反思是否会影响诊断校准尚未得到研究。诊断校准是诊断准确性与对该准确性的信心之间的关系，它会影响诊断性能，因为过度自信往往会导致过早的定论。本研究评估了在皮肤科深思熟虑的反思对诊断准确性和诊断校准的影响。

方法

巴西一所医学院的 61 名六年级学生被分配到反思组（RG）或对照组（CG）。在两组中，学生都使用相同的 12 个皮肤科图像，按顺序呈现，提供初始诊断和对该诊断的信心。随后，RG 学生使用结构化程序对病例进行反思，而 CG 学生则进行时间填充活动。所有学生随后提供最终诊断和对该诊断的信心。结果测量包括诊断准确性、信心和校准。

结果

与对照组相比，反思增加了诊断准确性（49.7±12.1 对 38.4±14.6；p=0.002），但不影响信心（64.3±13.2 对 58.9±20.1；p=0.228）或校准（0.15±0.16 对 0.20±0.19，p=0.197）。总体而言，病例难度影响校准，学生在更难的病例中表现出更多的过度自信（p<0.001）。