Peer Discussion Decreases Practice Intensity and Increases Certainty in Clinical Decision-Making Among Internal Medicine Residents.

Neha Bansal Etherington, Caitlin Clancy, R Benson Jones, C Jessica Dine, Gretchen Diemer

Abstract readMulticenter Study

In one paragraph

Article in Journal of graduate medical education, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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5 · Who and what money

Authors and funding

5 authors.

Neha Bansal Etheringtonis Assistant Professor of Clinical Medicine and Director of the Internal Medicine Sub-Internship, Lewis Katz School of Medicine, Temple University, Division of Hospital Medicine, Temple University Health System.

Caitlin Clancyis Instructor of Clinical Medicine, Division of Pulmonary, Allergy and Critical Care, University of Pennsylvania Health System, Perelman School of Medicine, University of Pennsylvania.

R Benson Jonesis a Fellow, Division of Endocrinology, Diabetes, and Metabolism, University of Pennsylvania Health System.

C Jessica Dineis Associate Professor of Medicine, Division of Pulmonary, Allergy and Critical Care, University of Pennsylvania Health System, and Associate Dean of Faculty Development, Perelman School of Medicine, Leonard Davis Institute of Health Economics, University of Pennsylvania.

Gretchen Diemeris Professor of Medicine, Vice Chair of Education for Medicine, and Senior Associate Dean of Graduate Medical Education and Affiliations, Sidney Kimmel Medical College, Thomas Jefferson University.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundTeam-based decision-making has been shown to reduce diagnostic error, increase clinical certainty, and decrease adverse events.

objectiveThis study aimed to assess the effect of peer discussion on resident practice intensity (PI) and clinical certainty (CC).

methodsA vignette-based instrument was adapted to measure PI, defined as the likelihood of ordering additional diagnostic tests, consultations or empiric treatment, and CC. Internal medicine residents at 7 programs in the Philadelphia area from April 2018 to June 2019 were eligible for inclusion in the study. Participants formed groups and completed each item of the instrument individually and as a group with time for peer discussion in between individual and group responses. Predicted group PI and CC scores were compared with measured group PI and CC scores, respectively, using paired

resultsSixty-nine groups participated in the study (response rate 34%, average group size 2.88). The measured group PI score (2.29, SD = 0.23) was significantly lower than the predicted group PI score (2.33, SD = 0.22) with a mean difference of 0.04 (SD = 0.10; 95% CI 0.02-0.07;

conclusionsIn this multicenter study of resident PI, peer discussion reduced PI and increased CC more than would be expected from averaging group members' individual scores.

Indexed as

Internship and ResidencyClinical Decision-MakingHumansPhiladelphia

Identifiers

PMID34178262

DOI10.4300/JGME-D-20-00948.1

PMCPMC8207905

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