Role of clinical context in residents’ physical examination diagnostic accuracy

Sibbald, Matthew; Panisko, Daniel M.; Cavalcanti, Rodrigo B.

doi:10.1111/j.1365-2923.2010.03896.x

Cited by 33 publications

(32 citation statements)

References 35 publications

(98 reference statements)

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“…No attempt was made to sequester residents as the purpose of the exam was entirely formative. Based on prior study with a comparable cohort of residents,12 we calculated a minimum sample size of 156 to detect a 20% difference in diagnostic accuracy assuming a power of 80% and α of 0.05.…”

Section: Methodsmentioning

confidence: 99%

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Do you have to re-examine to reconsider your diagnosis? Checklists and cardiac exam

et al. 2013

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Section: Methodsmentioning

confidence: 99%

“…It is estimated that there are several hundred potential cardiac physical diagnostic findings 11. Yet clinicians report using only three to five findings for most cardiac diagnoses 12 13. Do clinicians collect enough information to pick the most useful three to five findings?…”

Section: Introductionmentioning

confidence: 99%

Do you have to re-examine to reconsider your diagnosis? Checklists and cardiac exam

et al. 2013

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“…In clinical practice, most diagnoses are attained through clinical assessment. (24,25) Only 4.8%-7.5% of diagnoses are attained through further laboratory testing. (24,26) Clinical skills, which include history-taking and physical examination, were once the primary means by which diagnosis and clinical monitoring were done.…”

Section: Discussionmentioning

confidence: 99%

Are doctors assessing patients with hypertension appropriately at their initial presentation?

Wong

Lee

et al. 2015

smedj

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INTRODUCTIONThe aim of this study was to determine the extent to which primary care doctors assessed patients newly diagnosed with hypertension for the risk factors of cardiovascular disease (CVD) during the patients' first clinic visit for hypertension. The study also aimed to examine the trend of assessment for CVD risk factors over a 15-year period. METHODSThis retrospective study was conducted between January and May 2012. Data was extracted from the paperbased medical records of patients with hypertension using a 1:4 systematic random sampling method. Data collected included CVD risk factors and a history of target organ damage (TOD), which were identified during the patient's first visit to the primary care doctor for hypertension, as well as the results of the physical examinations and investigations performed during the same visit.RESULTS A total of 1,060 medical records were reviewed. We found that assessment of CVD risk factors during the first clinic visit for hypertension was poor (5.4%-40.8%). Assessments for a history of TOD were found in only 5.8%-11.8% of the records, and documented physical examinations and investigations for the assessment of TOD and secondary hypertension ranged from 0.1%-63.3%. Over time, there was a decreasing trend in the percentage of documented physical examinations performed, but an increasing trend in the percentage of investigations ordered. CONCLUSIONThere was poor assessment of the patients' CVD risk factors, secondary causes of hypertension and TOD at their first clinic visit for hypertension. The trends observed in the assessment suggest an over-reliance on investigations over clinical examinations.

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“…For instance, studies on cardiac diagnosis using a high‐fidelity simulator have identified that trainees rely excessively on the information provided from a short clinical stem. In these studies, participants were unable to overcome either a biased stem or their own initially misguided impression when performing a cardiac physical examination. These experiments suggest that trainees were unable to rely on cues from their physical examination and instead overvalued less predictive cues from clinical history in forming their diagnostic impressions.…”

Section: Application Of Cue Diagnosticity and Cue Utilisation In Medimentioning

confidence: 99%

Monitoring and regulation of learning in medical education: the need for predictive cues

2017

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ContextBeing able to accurately monitor learning activities is a key element in self‐regulated learning in all settings, including medical schools. Yet students’ ability to monitor their progress is often limited, leading to inefficient use of study time. Interventions that improve the accuracy of students’ monitoring can optimise self‐regulated learning, leading to higher achievement. This paper reviews findings from cognitive psychology and explores potential applications in medical education, as well as areas for future research.Cognitive PsychologyEffective monitoring depends on students’ ability to generate information (‘cues’) that accurately reflects their knowledge and skills. The ability of these ‘cues’ to predict achievement is referred to as ‘cue diagnosticity’. Interventions that improve the ability of students to elicit predictive cues typically fall into two categories: (i) self‐generation of cues and (ii) generation of cues that is delayed after self‐study. Providing feedback and support is useful when cues are predictive but may be too complex to be readily used.Application to Medical EducationLimited evidence exists about interventions to improve the accuracy of self‐monitoring among medical students or trainees. Developing interventions that foster use of predictive cues can enhance the accuracy of self‐monitoring, thereby improving self‐study and clinical reasoning. First, insight should be gained into the characteristics of predictive cues used by medical students and trainees. Next, predictive cue prompts should be designed and tested to improve monitoring and regulation of learning. Finally, the use of predictive cues should be explored in relation to teaching and learning clinical reasoning.ConclusionsImproving self‐regulated learning is important to help medical students and trainees efficiently acquire knowledge and skills necessary for clinical practice. Interventions that help students generate and use predictive cues hold the promise of improved self‐regulated learning and achievement. This framework is applicable to learning in several areas, including the development of clinical reasoning.

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Role of clinical context in residents’ physical examination diagnostic accuracy

Abstract: Clinical context is associated with enhanced diagnostic accuracy of common valvular lesions. However, this effect seems linked to heuristic hypothesis generation and may predispose to premature diagnostic closure, anchoring and confirmation bias.

Cited by 33 publications

References 35 publications

Do you have to re-examine to reconsider your diagnosis? Checklists and cardiac exam

Do you have to re-examine to reconsider your diagnosis? Checklists and cardiac exam

Are doctors assessing patients with hypertension appropriately at their initial presentation?

Monitoring and regulation of learning in medical education: the need for predictive cues

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