Gruppen L D, Palchik N S, Wolf F M, Laing T J, Oh M S, Davis W K
Arthritis Care Res. 1993 Jun;6(2):64-70. doi: 10.1002/art.1790060204.
Clinical data gathering is central to clinical competence. Although research has demonstrated the value to experienced clinicians of information obtained from the history, little is known of how medical students use this information. In the present study, two case simulations (in rheumatoid arthritis and systemic lupus erythematosis) were developed to assess medical student information gathering and utilization. The results indicate that most of the students were already considering the correct diagnosis as a possibility after the presenting complaint and patient description. However, the medical history exerted the strongest influence on transforming the correct diagnosis from just another diagnostic possibility into the favored diagnostic candidate. Students who failed to list the correct diagnosis in the differential diagnosis after obtaining the history were significantly less likely to reach the correct diagnosis at the end of the case. These results confirm the critical importance of the history in medical problem solving.
临床数据收集是临床能力的核心。尽管研究已经证明了从病史中获取的信息对经验丰富的临床医生的价值，但对于医学生如何使用这些信息却知之甚少。在本研究中，开发了两个病例模拟（类风湿性关节炎和系统性红斑狼疮）来评估医学生的信息收集和利用情况。结果表明，大多数学生在听取主诉和患者描述后已经将正确诊断视为一种可能性。然而，病史对将正确诊断从另一种诊断可能性转变为最有可能的诊断候选方面影响最大。在获取病史后未能在鉴别诊断中列出正确诊断的学生在病例结束时得出正确诊断的可能性要小得多。这些结果证实了病史在解决医学问题中的至关重要性。
