Medical student use of history and physical information in diagnostic reasoning

Gruppen, Larry D.; Palchik, Nancy S.; Wolf, Fredric M.; Laing, Timothy; Oh, Mary S.; Davis, Wayne K.

doi:10.1002/art.1790060204

Cited by 20 publications

(14 citation statements)

References 7 publications

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“…Research using the PMP method has revealed that students making the correct diagnosis at the end of history taking are from 12 times (95%CI= 3-46) to 33 times (95%CI= 5-218) more likely to reach a correct final diagnosis than those who fail to do so. 3 These results are similar to ours in indicating that a correct diagnosis after history taking contributes to making an accurate final diagnosis. Research has shown that diagnostic accuracy is improved by early and thorough problem representation, which is defined by a degree of abstraction from actual findings.…”

Section: Discussionsupporting

confidence: 90%

“…3 When diagnostic accuracy was compared between a case vignette containing all of the required diagnostic information versus the chief complaint format in which questions were asked to obtain information needed to make the diagnosis, there was a significantly lower accuracy rate with the chief complaint format. 9 In the present study, we used the latter format and students had to obtain data themselves, so the accuracy rate may have been lower.…”

Section: Discussionmentioning

confidence: 99%

“…In the past, relative risk has been used as a measure of association between the early consideration of a diagnostic hypothesis and the correctness of the final diagnosis. 3,8 In this study, the relative risk was calculated to assess the extent to which failing to include the correct diagnosis in the list of differential diagnoses made from the history or physical findings increased the possibility of misdiagnosis. The 95% confidence interval of the relative risk was calculated to assess the possibility of a final misdiagnosis when a student had not considered the correct diagnosis at a particular time versus the possibility when a student had done so.…”

Section: Discussionmentioning

confidence: 99%

“…With the PMP method, multiple options (20-30 options in one study and 15-40 options in another) for narrowing down the disease or for differential diagnosis are presented with respect to the case history, physical examination, and laboratory tests. 3,4 Thus, the actual diagnostic reasoning process, in which options must be generated by the doctor or study, may not be reflected. Research has shown a weak positive correlation among the processes of data inquiry, data interpretation and integration, and diagnosis elaboration, raising the issue of interdependence between these skills.…”

Section: Introductionmentioning

confidence: 98%

“…[1][2][3] This indicates that history taking is the most important part of the diagnostic process for both physicians and medical students. In those studies of physicians, actual cases or standard patients were used.…”

Section: Introductionmentioning

confidence: 99%

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The contribution of the medical history for the diagnosis of simulated cases by medical students

et al. 2012

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Objectives: The case history is an important part of diagnostic reasoning. The patient management problem method has been used in various studies, but may not reflect the actual reasoning process because a list of choices is given to the subjects in advance. This study investigated the contribution of the history to making the correct diagnosis by using clinical case simulation, in which students obtained clinical information by themselves. Methods: A prospective study was conducted. Ninety-four fifth-year medical students from Chiba University who underwent supervised clinical clerkships in 2009 were surveyed. Each student randomly selected 1 of 4 test cases and attempted to make a diagnosis through medical interview, physical examination, and laboratory tests, while the teacher acted as a patient. The student ranked the disease(s) diagnosed at each stage of the process. Diagnostic accuracy rates were compared using analysis of the χ2-test. Results: Sixty students (63.8 made a correct diagnosis, which was based on the history in 43 students (71.7, physical findings in 11 students (18.3, and laboratory data in 6 students (10.0. Compared with students who considered the correct diagnosis in their differential diagnosis after taking a history, students who failed to do so were 5.0 times (95 = 2.5-9.8) more likely to make a final misdiagnosis (χ[sup]2[/sup][sub](1)[/sub] = 30.73; p<0.001). Conclusions: History taking is especially important for making a correct diagnosis when students perform clinical case simulation. To improve the diagnostic reasoning skills, medical students should be trained in methods for inferring the correct diagnosis from the case history

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

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The contribution of the medical history for the diagnosis of simulated cases by medical students

et al. 2012

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Deficits in history taking skills among final year medical students in a family medicine course: A study from KSA

Alrasheedi

2018

Journal of Taibah University Medical Sciences

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Objectives History taking is considered an important diagnostic tool in medicine. Medical students should be competent in focused history-taking skills to reach initial diagnosis. The aim of this study was to identify deficits in history-taking skills among final year medical students in family medicine courses in Qassim University, KSA. Methods All objective structured clinical examination (OSCE) sheets were collected and analysed to evaluate the history-taking component of the final examination from 2016 until January 2018. Results A total of 94 OSCE sheets were evaluated. Achievement in some history taking skills of the students was low (differential diagnosis 31.9%, alarming symptoms of disease 39.4%, clarification of major complaint-associated symptoms 47.9%, and stress, anxiety, and depression screening 59.6%). However, the students' performances were better with respect to communication skills in general and exploration of the patients' ideas, concerns, and expectations. Significantly more male than female students had a better performance in some skills such as facilitating technique, appropriately exploring major complaint-associated symptoms, enquiring about differential diagnoses, and to rule out alarm symptoms. Conclusions In this study, the students' performance was generally better with respect to communication skills and psychosocial history. However, the students showed poor knowledge in other aspects of history-taking skills as they failed to formulate more than one hypothesis and to ask about alarm symptoms. Teaching communication and clinical reasoning skills and connecting physical and psychosocial aspects of patient care promotes understanding of the patient as a whole and should be taught in all courses of the clinical phase, with emphasis on bedside training.

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Problems in accurate medical diagnosis of depression in female patients

Floyd¹

1997

Social Science & Medicine

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Medical student use of history and physical information in diagnostic reasoning

Cited by 20 publications

References 7 publications

The contribution of the medical history for the diagnosis of simulated cases by medical students

The contribution of the medical history for the diagnosis of simulated cases by medical students

Deficits in history taking skills among final year medical students in a family medicine course: A study from KSA

Problems in accurate medical diagnosis of depression in female patients

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