Consistency in diagnostic suggestions does not influence the tendency to accept them

Kees Van den Berge, Silvia Mamede, Tamara van Gog, Jan van Saase, Remy Rikers

Abstract


Background: Studies suggest that residents tend to accept diagnostic suggestions, which could lead to diagnostic errors if the suggestion is incorrect. Those studies did not take into account that physicians in clinical practice will mainly encounter correct suggestions. The present study investigated residents’ diagnostic performance if they would first encounter a number of correct suggestions followed by a number of incorrect suggestions, and vice versa. It was hypothesized that more incorrect suggestions would be accepted if participants had first evaluated a series of correct suggestions.

Method: Residents (n = 38) evaluated suggested diagnoses on eight written clinical cases. Half of the participants first evaluated four correct suggestions and then evaluated four incorrect suggestions (C/I-condition). The other half started with the four incorrect suggestions followed by the correct suggestions (I/C-condition).

Results: Our findings show that the evaluation score in the C/I condition (M = 2.87, MSE = 0.14) equaled that in the I/C condition (M = 2.66, MSE = 0.14), F(1,36) = 1.09, p = 0.30, ns, meaning that consistency in preceding suggested diagnoses did not influence the tendency to accept subsequent diagnostic suggestions. There was, however, a significant interaction effect between case order and phase, F(1,36) = 11.82, p = 0.001, ηp2 = 0.25, demonstrating that the score on cases with correct suggestions was higher than the score on cases with incorrect suggestions.

Conclusion: These findings indicate that consistency in preceding correct or incorrect diagnostic suggestions did not influence the tendency to accept or reject subsequent suggestions. However, overall residents still showed a tendency to accept diagnostic suggestions, which may lead to diagnostic errors if the suggestion is incorrect.


Keywords


clinical reasoning; diagnostic error; confirmation bias

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CMEJ ~ Canadian Medical Education Journal
Jennifer O'Brien PhD, Managing Editor, University of Saskatchewan; E-mail: cmej.manager@usask.ca


ISSN 1923-1202