Kaminska Malgorzata E, Rikers Remy M J P
Northern Medical Program, University of Northern British Columbia, Prince George, British Columbia, Canada.
Department of Family Practice, University of British Columbia, Vancouver, Canada.
Teach Learn Med. 2022 Apr-May;34(2):178-186. doi: 10.1080/10401334.2021.1949995. Epub 2021 Aug 4.
In Medicine, arriving at the correct diagnosis is of paramount importance for patient health and safety, yet is a difficult task especially when a patient presents with symptoms that do not fit typical patterns of disease. This task can be further complicated by errors of judgment, with the failure to consider all possible diagnoses being the most common of such errors. In this study, we investigated the process of differential diagnosis generation within the growing evidence that diagnostic performance can be increased by activities such as walking as was previously shown in Oppezzo and Schwartz's 2014 study. It was hypothesized that an increase in performance, as expressed by a greater number of plausible differential diagnoses, would be seen in the walking group. Eighteen medical students in their last two months of pre-clerkship training and eighteen second year family medicine residents were shown four different lists of a constellation of signs and symptoms. Participants were asked to generate differential diagnoses over five minutes per each list. All participants sat when completing the first two lists (pretest phase), and then were equally and randomly assigned to sitting versus walking on a treadmill when completing the last two lists (post-test phase). The number of total and unique differential diagnoses generated was determined, before being submitted to a three-member expert panel who identified appropriate unique differential diagnoses. Two-way mixed ANOVAs were conducted to investigate the impact of exercise on the number of total, unique, and appropriate unique ideas generated and compared between pretest and post-test phases. We conclude that there is neither an increase nor a decrease in the number or quality of differential diagnoses generated by the sitting and walking groups within a population that has acquired some level of expertise.
在医学领域，做出正确诊断对于患者的健康和安全至关重要，但这是一项艰巨的任务，尤其是当患者出现不符合典型疾病模式的症状时。判断失误会使这项任务进一步复杂化，其中最常见的失误是未能考虑所有可能的诊断。在本研究中，我们在越来越多的证据表明诸如行走等活动可以提高诊断性能（如奥佩佐和施瓦茨2014年的研究所显示）的背景下，研究了鉴别诊断生成的过程。研究假设，行走组在鉴别诊断的数量上会有所增加，即表现为更多合理的鉴别诊断。向18名处于临床实习前最后两个月的医学生和18名二年级家庭医学住院医师展示了四组不同的症状和体征清单。要求参与者针对每组清单在五分钟内生成鉴别诊断。所有参与者在完成前两组清单时坐着（预测试阶段），然后在完成后两组清单时被平均且随机地分配为坐着或在跑步机上行走（后测试阶段）。在将生成的鉴别诊断总数和独特鉴别诊断数提交给一个由三名专家组成的小组之前，先确定这些数量，该专家小组会确定适当的独特鉴别诊断。进行双向混合方差分析，以研究运动对在预测试和后测试阶段之间生成的鉴别诊断总数、独特鉴别诊断数以及适当独特鉴别诊断数的影响，并进行比较。我们得出结论，在已经获得一定专业水平的人群中，坐着组和行走组生成的鉴别诊断数量和质量既没有增加也没有减少。
