元记忆技巧在儿科核心实习中生成有效鉴别诊断的影响。

Impact of meta-memory techniques in generating effective differential diagnoses in a pediatric core clerkship.

作者信息

Tiamiyu Khadijah, Pahwa Amit, Gates Megan, Bertram Amanda, Murphy Emily

机构信息

Department of Pediatrics, Northwestern University, Chicago, IL, USA.

Department of Pediatrics, Johns Hopkins University, Baltimore, MD, USA.

出版信息

Diagnosis (Berl). 2024 Dec 4;12(2):282-285. doi: 10.1515/dx-2024-0133. eCollection 2025 May 1.

DOI:10.1515/dx-2024-0133

PMID:39625192

Abstract

OBJECTIVES

We primarily assessed differences in differential diagnosis (DDx) efficacy of initial and refined top diagnoses (tDDx) and "can't miss" DDx (CMDx) between 3 MMTs (Constellations, Mental CT, and VINDICATES).

METHODS

Pediatric clerkship students participated in two 1-h case-based sessions. The case was presented in three aliquots. Students were randomly assigned to MMT groups. Assigned MMTs were used to generate the initial tDDx and CMDx following aliquot 1. tDDx and CMDx were refined following both aliquots 2 and 3. Group DDx responses and student affective data were collected via survey. DDx efficacy was defined using pooled faculty responses and scoring was done by consensus.

RESULTS

There was no significant difference in scores between MMT groups, except the second iteration of CMDx in Case A (Constellations 50 % [interquartile range, IQR, 50-100], Mental CT 50 % [50-100], VINDICATES 0 % [0-50], p=0.02). Students' self-reported confidence in generating (p<0.001) and refining (p<0.001) their DDx significantly increased after the curriculum.

CONCLUSIONS

Although prior studies identified a differential effect of MMTs on DDx generation, we did not observe a difference in initial or refined DDx efficacy between MMTs. .

摘要

目的

我们主要评估了三种医学思维模式（星座模式、心理CT模式和VINDICATES模式）在初始和细化的首要诊断（tDDx）以及“不能漏诊”的诊断（CMDx）的鉴别诊断（DDx）效能方面的差异。

方法

儿科见习学生参加了两个1小时的基于病例的课程。病例分三次呈现。学生被随机分配到医学思维模式组。在第一次病例呈现后，使用分配的医学思维模式生成初始的tDDx和CMDx。在第二次和第三次病例呈现后，对tDDx和CMDx进行细化。通过调查收集各组的DDx反应和学生的情感数据。DDx效能通过汇总教师的反应来定义，并通过共识进行评分。

结果

医学思维模式组之间的得分没有显著差异，但病例A中CMDx的第二次迭代除外（星座模式50%[四分位间距，IQR，50 - 100]，心理CT模式50%[50 - 100]，VINDICATES模式0%[0 - 50]，p = 0.02）。课程结束后，学生自我报告的生成（p < 0.001）和细化（p < 0.001）DDx的信心显著增加。