Frank Luca, Hueber Susann, van der Keylen Piet, Roos Marco
Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Allgemeinmedizinisches Institut, Erlangen, Germany.
GMS J Med Educ. 2019 Nov 15;36(6):Doc84. doi: 10.3205/zma001292. eCollection 2019.
Giving information and providing advice on diagnostic tests is one of the tasks physicians must carry out personally. To do so, they must evaluate the evidence and integrate their findings into everyday practice. Clinical decisions should be based on evidence. How well current medical education prepares for such evidence-based clinical decision-making is largely unclear. Therefore, it was examined how confident medical students are in clinical decision-making based on evidence using epidemiological data. It was examined whether the decision-making confidence increases the higher the semester. Further questions were whether scientifically active medical students show higher decision-making confidence and whether the representation of figures as pictograms rather than tables positively influences the decision-making confidence. An online survey of the medical students of the Friedrich-Alexander-University Erlangen-Nürnberg was carried out. Respondents were presented with three clinical decision-making situations in random order for evaluation in the form of screening scenarios. In each case, the decision-making confidence also had to be specified. The scenarios contained only epidemiological data on existing screening tests. For each scenario, the numbers were presented as a table or a pictogram in a random fashion. In order to avoid false confidence resulting from preconceived opinions neither the illnesses nor the screening tests were mentioned by name. Answers from 171 students were evaluated. Decision-making confidence in dealing with the numbers does not increase in higher semesters ( =0.018, =0.41). Scientific work is not associated with a higher decision-making confidence ((169)=-1.26, =0.11, =-0.19). Presentation as a pictogram leads to a higher decision-making confidence compared to tables (Pictogram: =2.33, =1.07, Table with numbers: =2.64, =1.11, (511)=3.21, <0.01, =0.28). Medical students from higher semesters show no higher decision-making confidence compared to medical students from lower semesters. Curricular events and scientific work, such as a doctoral thesis, do not seem to strengthen the required skills sufficiently. If evidence is presented in the form of pictograms, this seems to improve student confidence in decision-making.
提供诊断测试信息并给出建议是医生必须亲自执行的任务之一。要做到这一点，他们必须评估证据并将调查结果融入日常实践。临床决策应基于证据。目前的医学教育在多大程度上为这种基于证据的临床决策做好准备，很大程度上尚不清楚。因此，研究人员通过流行病学数据研究了医学生在基于证据的临床决策中的自信程度。研究还探讨了决策信心是否会随着学期的升高而增加。其他问题包括积极从事科研的医学生是否表现出更高的决策信心，以及将数据以象形图而非表格的形式呈现是否会对决策信心产生积极影响。研究人员对埃尔朗根 - 纽伦堡弗里德里希 - 亚历山大大学的医学生进行了一项在线调查。以筛查场景的形式，随机向受访者呈现三种临床决策情况以供评估。在每种情况下，还必须明确决策信心。这些场景仅包含现有筛查测试的流行病学数据。对于每个场景，数据以表格或象形图的形式随机呈现。为了避免因先入之见导致的虚假信心，既未提及疾病名称也未提及筛查测试名称。对171名学生的答案进行了评估。处理数据时的决策信心在高年级学期并未增加（=0.018，=0.41）。科研工作与更高的决策信心无关（(169)= -1.26，=0.11，= -0.19）。与表格相比，以象形图形式呈现会带来更高的决策信心（象形图：=2.33，=1.07，数字表格：=2.64，=1.11，(511)=3.21，<0.01，=0.28）。与低年级医学生相比，高年级医学生并未表现出更高的决策信心。课程活动和科研工作，如博士论文，似乎并未充分强化所需技能。如果以象形图的形式呈现证据，这似乎会提高学生的决策信心。
