College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Ar Rimayah, Riyadh, 14611, Saudi Arabia.
BMC Med Educ. 2022 Mar 16;22(1):182. doi: 10.1186/s12909-022-03212-1.
Diagnostic error is a major source of patient suffering. Researchshows that physicians experience frequent interruptions while being engaged with patients and indicate that diagnostic accuracy may be impaired as a result. Since most studies in the field are observational, there is as yet no evidence suggesting a direct causal link between being interrupted and diagnostic error. Theexperiments reported in this article were intended to assess this hypothesis.
Three experiments were conducted to test the hypothesis that interruptions hurt diagnostic reasoning and increase time on task. In the first experiment (N = 42), internal medicine residents, while diagnosing vignettes of actual clinical cases were interrupted halfway with a task unrelated to medicine, solving word-spotting puzzles and anagrams. In the second experiment (N = 78), the interruptions were medically relevant ones. In the third experiment (N = 30), we put additional time pressure on the participants. In all these experiments, a control group diagnosed the cases without interruption. Dependent variables were diagnostic accuracy and amount of time spent on the vignettes.
In none of the experiments interruptions were demonstrated to influence diagnostic accuracy. In Experiment 1: Mean of interrupted group was 0.88 (SD = 0.37) versus non- interrupted group 0.91 (SD = 0.32). In Experiment 2: Mean of interrupted group was 0.95 (SD = 0.32) versus non-interrupted group 0.94 (SD = 0.38). In Experiment 3: Mean of interrupted group was 0.42 (SD = 0.12) versus non-interrupted group 0.37 (SD = 0.08). Although interrupted residents in all experiments needed more time to complete the diagnostic task, only in Experiment 2, this effect was statistically significant.
These three experiments, taken together, failed to demonstrate negative effects of interruptions on diagnostic reasoning. Perhaps physicians who are interrupted may still have sufficient cognitive resources available to recover from it most of the time.
诊断错误是患者痛苦的主要来源。研究表明，医生在与患者接触时经常会被打断，并且认为这可能会影响诊断的准确性。由于该领域的大多数研究都是观察性的，因此尚无证据表明被打断与诊断错误之间存在直接的因果关系。本文报道的实验旨在评估这一假设。
进行了三项实验来检验中断会损害诊断推理并增加任务时间的假设。在第一项实验（N=42）中，内科住院医师在诊断实际临床病例的案例时被中途打断，进行与医学无关的任务，即解决单词识别谜题和字谜。在第二项实验（N=78）中，中断是医学相关的。在第三项实验（N=30）中，我们给参与者增加了额外的时间压力。在所有这些实验中，对照组在没有中断的情况下诊断案例。因变量是诊断的准确性和花费在案例上的时间。
在这些实验中，中断都没有被证明会影响诊断的准确性。在实验 1 中：中断组的平均值为 0.88（SD=0.37），而非中断组的平均值为 0.91（SD=0.32）。在实验 2 中：中断组的平均值为 0.95（SD=0.32），而非中断组的平均值为 0.94（SD=0.38）。在实验 3 中：中断组的平均值为 0.42（SD=0.12），而非中断组的平均值为 0.37（SD=0.08）。尽管所有实验中的中断组都需要更多的时间来完成诊断任务，但只有在实验 2 中，这种效果才具有统计学意义。
这三项实验都未能证明中断对诊断推理的负面影响。也许被打断的医生仍然有足够的认知资源可以恢复，在大多数情况下都是如此。
