Department of General Practice, Erasmus Medical Centre, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
Institute of Medical Education Research Rotterdam, Erasmus Medical Centre, Rotterdam, The Netherlands.
Adv Health Sci Educ Theory Pract. 2022 Mar;27(1):189-200. doi: 10.1007/s10459-021-10080-9. Epub 2021 Nov 5.
When physicians do not estimate their diagnostic accuracy correctly, i.e. show inaccurate diagnostic calibration, diagnostic errors or overtesting can occur. A previous study showed that physicians' diagnostic calibration for easy cases improved, after they received feedback on their previous diagnoses. We investigated whether diagnostic calibration would also improve from this feedback when cases were more difficult. Sixty-nine general-practice residents were randomly assigned to one of two conditions. In the feedback condition, they diagnosed a case, rated their confidence in their diagnosis, their invested mental effort, and case complexity, and then were shown the correct diagnosis (feedback). This was repeated for 12 cases. Participants in the control condition did the same without receiving feedback. We analysed calibration in terms of (1) absolute accuracy (absolute difference between diagnostic accuracy and confidence), and (2) bias (confidence minus diagnostic calibration). There was no difference between the conditions in the measurements of calibration (absolute accuracy, p = .204; bias, p = .176). Post-hoc analyses showed that on correctly diagnosed cases (on which participants are either accurate or underconfident), calibration in the feedback condition was less accurate than in the control condition, p = .013. This study shows that feedback on diagnostic performance did not improve physicians' calibration for more difficult cases. One explanation could be that participants were confronted with their mistakes and thereafter lowered their confidence ratings even if cases were diagnosed correctly. This shows how difficult it is to improve diagnostic calibration, which is important to prevent diagnostic errors or maltreatment.
当医生不能正确估计他们的诊断准确性，即表现出不准确的诊断校准时，就可能会出现诊断错误或过度检测。先前的一项研究表明，在收到对之前诊断的反馈后，医生对简单病例的诊断校准得到了改善。我们调查了当病例更难时，这种反馈是否也能提高诊断校准。69 名全科住院医师被随机分配到两个条件之一。在反馈条件下，他们诊断一个病例，评估他们对诊断的信心、投入的心理努力和病例的复杂性，然后显示正确的诊断（反馈）。这重复了 12 次。对照组的参与者在没有收到反馈的情况下做了同样的事情。我们根据（1）绝对准确性（诊断准确性和信心之间的绝对差异）和（2）偏差（信心减去诊断校准）来分析校准。两种情况下的校准测量结果没有差异（绝对准确性，p=0.204；偏差，p=0.176）。事后分析表明，在正确诊断的病例上（参与者要么准确，要么信心不足），反馈条件下的校准比对照组更不准确，p=0.013。这项研究表明，对诊断表现的反馈并没有提高医生对更困难病例的校准。一种解释可能是，参与者面对自己的错误，即使病例诊断正确，他们的信心评级也会降低。这表明提高诊断校准有多么困难，这对于防止诊断错误或滥用诊断至关重要。
