Department of Medicine, University of California Davis, Sacramento, California.
Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado.
J Hosp Med. 2019 Oct 1;14(10):622-625. doi: 10.12788/jhm.3262. Epub 2019 Aug 16.
Appropriate calibration of clinical reasoning is critical to becoming a competent physician. Lack of follow-up after transitions of care can present a barrier to calibration. This study aimed to implement structured feedback about clinical reasoning for residents performing overnight admissions, measure the frequency of diagnostic changes, and determine how feedback impacts learners' self-efficacy. Trainees shared feedback via a structured form within their electronic health record's secure messaging system. Forms were analyzed for diagnostic changes. Surveys evaluated comfort with sharing feedback, self-efficacy in identifying and mitigating cognitive biases' negative effects, and perceived educational value of night admissions-all of which improved after implementation. Analysis of 544 forms revealed a 43.7% diagnostic change rate spanning the transition from night-shift to day-shift providers; of the changes made, 29% (12.7% of cases overall) were major changes. This study suggests that structured feedback on clinical reasoning for overnight admissions is a promising approach to improve residents' diagnostic calibration, particularly given how often diagnostic changes occur.
临床推理的适当校准对于成为一名合格的医生至关重要。在医疗护理交接后缺乏跟进可能会成为校准的障碍。本研究旨在为执行夜间入院的住院医师提供关于临床推理的结构化反馈，衡量诊断变化的频率，并确定反馈如何影响学习者的自我效能感。学员通过电子病历的安全消息系统中的结构化表格分享反馈。表格分析用于诊断变化。调查评估了分享反馈的舒适度、在识别和减轻认知偏差的负面影响方面的自我效能感，以及对夜间入院的教育价值的感知——所有这些在实施后都有所提高。对 544 份表格的分析显示，从夜班到白班提供者的过渡期间诊断变化率为 43.7%；在做出的更改中，29%（总体占 12.7%）是重大更改。这项研究表明，针对夜间入院的临床推理进行结构化反馈是一种很有前途的方法，可以提高住院医师的诊断校准能力，特别是考虑到诊断变化的频率。
