Evidence map›Paper›PMID 33882919›Full record

ArticleBMC medical education2021

The relationship between time to diagnose and diagnostic accuracy among internal medicine residents: a randomized experiment.

J Staal, J Alsma, S Mamede, A P J Olson, G Prins-van Gilst, S E Geerlings, M Plesac, M A Sundberg, M A Frens, H G Schmidt and 2 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in BMC medical education, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed.

  1. Impact of performance and information feedback on medical interns' confidence-accuracy calibration.Advances in health sciences education : theory and practice · 2024
    Trial
  2. Article
  3. Article
  4. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors.

J StaalErasmus Medical Center Rotterdam, Institute of Medical Education Research Rotterdam, Rotterdam, The Netherlands. j.staal@erasmusmc.nl.
J AlsmaDepartment of Internal Medicine, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands.
S MamedeErasmus Medical Center Rotterdam, Institute of Medical Education Research Rotterdam, Rotterdam, The Netherlands.
A P J OlsonDivision of General Internal Medicine, University of Minnesota, Section of Hospital Medicine, Minneapolis, USA.
G Prins-van GilstDepartment of Internal Medicine, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands.
S E GeerlingsDepartment of Internal Medicine and Department of Infectious Diseases, Academic Medical Center Amsterdam, Amsterdam, The Netherlands.
M PlesacDivision of General Internal Medicine, University of Minnesota, Section of Hospital Medicine, Minneapolis, USA.
M A SundbergDivision of General Internal Medicine, University of Minnesota, Section of Hospital Medicine, Minneapolis, USA.
M A FrensDepartment of Neuroscience, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands.
H G SchmidtErasmus Medical Center Rotterdam, Institute of Medical Education Research Rotterdam, Rotterdam, The Netherlands.
W W Van den BroekErasmus Medical Center Rotterdam, Institute of Medical Education Research Rotterdam, Rotterdam, The Netherlands.
L ZwaanErasmus Medical Center Rotterdam, Institute of Medical Education Research Rotterdam, Rotterdam, The Netherlands.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundDiagnostic errors have been attributed to cognitive biases (reasoning shortcuts), which are thought to result from fast reasoning. Suggested solutions include slowing down the reasoning process. However, slower reasoning is not necessarily more accurate than faster reasoning. In this study, we studied the relationship between time to diagnose and diagnostic accuracy.

methodsWe conducted a multi-center within-subjects experiment where we prospectively induced availability bias (using Mamede et al.'s methodology) in 117 internal medicine residents. Subsequently, residents diagnosed cases that resembled those bias cases but had another correct diagnosis. We determined whether residents were correct, incorrect due to bias (i.e. they provided the diagnosis induced by availability bias) or due to other causes (i.e. they provided another incorrect diagnosis) and compared time to diagnose.

resultsWe did not successfully induce bias: no significant effect of availability bias was found. Therefore, we compared correct diagnoses to all incorrect diagnoses. Residents reached correct diagnoses faster than incorrect diagnoses (115 s vs. 129 s, p < .001). Exploratory analyses of cases where bias was induced showed a trend of time to diagnose for bias diagnoses to be more similar to correct diagnoses (115 s vs 115 s, p = .971) than to other errors (115 s vs 136 s, p = .082).

conclusionsWe showed that correct diagnoses were made faster than incorrect diagnoses, even within subjects. Errors due to availability bias may be different: exploratory analyses suggest a trend that biased cases were diagnosed faster than incorrect diagnoses. The hypothesis that fast reasoning leads to diagnostic errors should be revisited, but more research into the characteristics of cognitive biases is important because they may be different from other causes of diagnostic errors.

Indexed as

Internal MedicineProblem SolvingBiasDiagnostic ErrorsHumansCognitive biasDecision makingDiagnostic errorPatient safety

Identifiers

PMID33882919
PMCPMC8061054

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.