Medical Student Collaboration Improves Diagnosis Accuracy

Laura Putre

January 21, 2015

Medical students who work in teams may have an advantage in making diagnoses compared with those who work alone, according to a new study that examined the diagnosing accuracy of 88 fourth-year medical students.

Wolf E. Hautz, MD, from Charité Charité Campus Mitte, Germany, and colleagues present their findings in research letter published in the January 20 issue of JAMA.

Students either worked in pairs or alone. The 60 paired students made correct diagnoses 67.78% of the time compared with 50.00% of the time for students who worked alone (difference, 17.78%; 95% confidence interval [CI], 5.83%-29.73%; P = .004).

"[C]ollaboration may have helped correct errors, fill knowledge gaps, and counteract reasoning flaws," the study authors write, noting that diagnostic errors substantially lead to preventable medical error.

The study's student volunteers evaluated six simulated cases of respiratory distress on a computer and then had to determine a diagnosis for each case.

Each case began with a video presentation of the patient. Students could then order any of 30 diagnostic tests, choosing from a list of 20 possible diagnoses. Test results came back as they would in the real world; for instance, as X-rays or auscultation sounds.

"Pairs selected more relevant tests on average, but did so only when incorrect," the authors write.

The paired students took, on average, 2:02 minutes longer than individuals to reach a diagnosis, but the tests they selected would have taken 6:15 minutes (95% confidence interval, −12:08 to −0:21 minutes) less in real time.

In addition, the investigators measured how confident students were in their diagnoses. Overall, pairs were more confident than individuals, but more confidence did not lead to more correct diagnoses. The researchers said future studies might look at whether differing confidence levels within a team could contribute to an incorrect diagnosis.

One coauthor has reported receiving grants from Ethical Committee Vienna Faculty of Medicine, Zon-Mw-Dutch Research Community, Care Fusion, Deltex, Fresenius, Hutchinson, Medizinische Congressorganisation Nürnberg, Novartis, Pajunk, Grünenthal, Köhler Chemie, Roche, Orion Pharma, Outcome Europe Sàrl, University Hospital Stavanger, Arbeitsgemeinschaft Industrieller Forschungsvereinigungen, Bund Deutscher Anästhesisten, Bundesministerium für Bildung und Forschung, Deutsche Krebshilfe, Deutsches Zentrum für Luftund Raumfahrt, German Research Society, Gesellschaft für Internationale Zusammenarbeit, Inner University Grants, Stifterverband, and the European Commission; and receiving personal fees from B. Braun Foundation, ConvaTec International Service GmbH, Pfizer Pharma, Vifor Pharma, Fresenius Kabi, and Georg Thieme Verlag. The other authors have disclosed no relevant financial relationships.

JAMA. 2015;313:303-304. Extract


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