Comparison of Vignettes, Standardized Patients, and Chart Abstraction

Peabody, John; Luck, James V.; Glassman, Peter; Dresselhaus, Timothy R.; Lee, Martin L.

doi:10.1001/jama.283.13.1715

Cited by 1,050 publications

(358 citation statements)

References 58 publications

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“…Direct observation of the performance of providers can be completed through the use of standardized patients 31 or video recording of clinicians interacting with patients. 32 Similarly, assessments of competency, including questionnaires about knowledge, can be completed (e.g., those done as part of the requirements for certification by the American Board of Internal Medicine or through completion of clinical vignettes).…”

Section: At the Care-provider Levelmentioning

confidence: 99%

The knowledge-to-action cycle: identifying the gaps

Kitson¹,

Straus²

2009

Canadian Medical Association Journal

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Section: At the Care-provider Levelmentioning

confidence: 99%

The knowledge-to-action cycle: identifying the gaps

Kitson¹,

Straus²

2009

Canadian Medical Association Journal

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“…Another concern might be the use of vignettes to search for evidence of stereotyping in decision-making, although several studies have shown vignettes to be accurate in reflecting actual clinical practice. [39][40][41][42][43] The survey response rate among students at participating schools (40.2 %) is low enough that some might question the validity of the sample. Although our data show relatively few differences among survey respondents and the larger population of senior medical students as depicted by the AAMC survey, suggesting sample validity, it is possible that non-participants and students from non-participating schools may demonstrate different decision-making tendencies than those reflected in these data.…”

Section: Discussionmentioning

confidence: 99%

Racial, Gender, and Socioeconomic Status Bias in Senior Medical Student Clinical Decision-Making: A National Survey

et al. 2015

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BACKGROUND:Research suggests stereotyping by clinicians as one contributor to racial and gender-based health disparities. It is necessary to understand the origins of such biases before interventions can be developed to eliminate them. As a first step toward this understanding, we tested for the presence of bias in senior medical students. OBJECTIVE: The purpose of the study was to determine whether bias based on race, gender, or socioeconomic status influenced clinical decision-making among medical students. DESIGN: We surveyed seniors at 84 medical schools, who were required to choose between two clinically equivalent management options for a set of cardiac patient vignettes. We examined variations in student recommendations based on patient race, gender, and socioeconomic status. PARTICIPANTS: The study included senior medical students. MAIN MEASURES: We investigated the percentage of students selecting cardiac procedural options for vignette patients, analyzed by patient race, gender, and socioeconomic status. KEY RESULTS: Among 4,603 returned surveys, we found no evidence in the overall sample supporting racial or gender bias in student clinical decision-making. Students were slightly more likely to recommend cardiac procedural options for black (43.9 %) vs. white (42 %, p=.03) patients; there was no difference by patient gender. Patient socioeconomic status was the strongest predictor of student recommendations, with patients described as having the highest socioeconomic status most likely to receive procedural care recommendations (50.3 % vs. 43.2 % for those in the lowest socioeconomic status group, p<.001). Analysis by subgroup, however, showed significant regional geographic variation in the influence of patient race and gender on decision-making. Multilevel analysis showed that white female patients were least likely to receive procedural recommendations. CONCLUSIONS: In the sample as a whole, we found no evidence of racial or gender bias in student clinical decision-making. However, we did find evidence of bias with regard to the influence of patient socioeconomic status, geographic variations, and the influence of interactions b e t w e e n p a t i e n t r ac e a nd g e nd er o n s t u d en t recommendations.

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“…Although often criticized because they do not reflect actual practice which may influence results and conclusions of studies, well designed vignette studies can be practical, offer flexibility, avoid ethical and observational issues and be generalizable to real world settings (Evans et al, 2015;Peabody, Luck, Glassman, Dresselhaus & Lee, 2000;Rutten, Harting, Rutten, Bekkering & Kremers, 2006). Clinical vignettes are an inexpensive option to control multiple variables, collect information simultaneously from multiple sources, and isolate clinical decision making.…”

Section: Overview Of Problemmentioning

confidence: 99%

“…For instance, real patients may make measurement by direct observation difficult to apply, especially in larger samples, can be expensive and time-consuming, and is potentially subject to a Hawthorne effect (Rutten et al, 2006). Use of real patients may result in insufficient case mix (Peabody et al, 2000) which may inadvertently introduce sampling bias, especially as it relates to MDT. The Derangement syndrome is the most common classification in the spine (78%, May, 2006) and in the extremity (37%, May & Rosedale, 2012).…”

Section: Clinical Vignettesmentioning

confidence: 99%

“…Another potential limitation is the use of clinical vignettes as an alternative to real patients. It has been argued that vignettes cannot measure correspondence of hypothetical behavior and real world behavior (Evans et al, 2015) and may not capture the subtlety of a patients' presentation, oversimplify findings making a diagnosis easier and potentially inflating calculated agreement (Peabody et al, 2000;Werneke, Hart, Deutscher and Stratford, 2011). However, clinical vignettes offer the convenience of collecting information from multiple sources simultaneously while allowing for the flexibility of variable manipulation to ensure a heterogeneous sample.…”

Section: Limitationsmentioning

confidence: 99%

See 1 more Smart Citation

Inter-rater reliability of the McKenzie System of Mechanical Diagnosis and Therapy in the examination of the knee

Willis

Rosedale

Rastogi

et al. 2016

Journal of Manual & Manipulative Therapy

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Objective: The purpose of this thesis was to investigate the inter-rater reliability of the McKenzie System of Mechanical Diagnosis and Therapy (MDT) when classifying patients with musculoskeletal knee pain using clinical vignettes. Methods: This study was divided into two phases. First, ten clinicians experienced in the use of MDT were randomly recruited to write a total of 60 clinical vignettes based upon the initial assessment of past patients with knee pain. Second, six different MDT raters were recruited to rate 53 selected vignettes and reliability was determined using Fleiss Kappa. Results: There was "substantial agreement" among six MDT raters classifying the clinical vignettes into one of four categories (kappa=0.72). There was no statistically significant difference between therapists with different levels of training. Significance: These findings indicate that the McKenzie System of MDT is a reliable method of classifying patients presenting with musculoskeletal knee pain when using clinical vignettes.

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Comparison of Vignettes, Standardized Patients, and Chart Abstraction

Cited by 1,050 publications

References 58 publications

The knowledge-to-action cycle: identifying the gaps

The knowledge-to-action cycle: identifying the gaps

Racial, Gender, and Socioeconomic Status Bias in Senior Medical Student Clinical Decision-Making: A National Survey

Inter-rater reliability of the McKenzie System of Mechanical Diagnosis and Therapy in the examination of the knee

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