Abstract:
CONTEXT:Clinical context may act as both an aid to decision making and a source of bias contributing to medical error. The effect of clinical history, a form of clinical context, on the diagnostic accuracy of the physical examination is unknown. METHODS:We randomised internal medicine residents to receive either no history or a short stem suggestive of one of six cardiac valvular diagnoses prior to a 10-minute objective structured clinical examination station assessing cardiac examination skills using a high-fidelity simulator. Clinical performance and diagnostic accuracy were compared using a standardised checklist. RESULTS:A total of 159 internal medicine residents were enrolled after providing informed consent. Of these, 80% arrived at the correct diagnosis, with diagnostic accuracy varying significantly by valve lesion (49-100%; p < 0.0001). Clinical context was associated with improved diagnostic accuracy compared with no history (90% versus 74%; likelihood ratio= 6.6, p < 0.0001), but was not associated with trainees' ability to identify and characterise physical findings. Among residents given clinical context, higher diagnostic accuracy was only achieved by those able to correctly predict the diagnosis from the history. CONCLUSIONS: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.
journal_name
Med Educjournal_title
Medical educationauthors
Sibbald M,Panisko D,Cavalcanti RBdoi
10.1111/j.1365-2923.2010.03896.xsubject
Has Abstractpub_date
2011-04-01 00:00:00pages
415-21issue
4eissn
0308-0110issn
1365-2923journal_volume
45pub_type
杂志文章,随机对照试验abstract:CONTEXT:The assessment of ethical problem solving in medicine has been controversial and challenging. The purposes of this study were: (i) to create a new instrument to measure doctors' decisions on and reasoning approach towards resolving ethical problems; (ii) to evaluate the scores generated by the new instrument fo...
journal_title:Medical education
pub_type: 杂志文章
doi:10.1111/j.1365-2923.2009.03516.x
更新日期:2009-12-01 00:00:00
abstract::In a study of the development of professional attitudes in medical students, a modified version of the Medical Attitudes Inventory (Harris, 1974) was administered to 141 male and female first year medical students in Lagos, Nigeria. The results show that the students have well-defined attitudes on certain issues and a...
journal_title:Medical education
pub_type: 杂志文章
doi:10.1111/j.1365-2923.1978.tb01417.x
更新日期:1978-11-01 00:00:00
abstract::Continuing education should be convenient, relevant, individualized, systematic and include means of assessment. Educational technology provides the link between teaching and learning; it should accommodate the essential interactions between learner, instructor, environment and material. Media in open learning systems...
journal_title:Medical education
pub_type: 杂志文章
doi:10.1111/j.1365-2923.1985.tb01328.x
更新日期:1985-07-01 00:00:00
abstract:AIM:To examine how students' evaluations of the environment, process and outcome of clinical learning interrelated and correlated with assessment results. METHOD:A post hoc study in the 3rd of 5 years in a student-centred, horizontally integrated, objective-based medical curriculum. In the last week of each module, st...
journal_title:Medical education
pub_type: 杂志文章,多中心研究
doi:10.1111/j.1365-2929.2006.02507.x
更新日期:2006-07-01 00:00:00
abstract::In response to the increased need to train well-rounded general practitioners within a limited time schedule, the teaching staff developed a self-instructional videotape programme devoted to suicide assessment. This tape, if successful, was to serve as a pilot for a full series of 18 tapes devoted to the assessment an...
journal_title:Medical education
pub_type: 杂志文章
doi:10.1111/j.1365-2923.1980.tb02609.x
更新日期:1980-01-01 00:00:00
abstract:CONTEXT:Understanding self-regulated learning (SRL) is complicated due to the different measures used to identify the key SRL processes. There is a growing trend in applying event measures of SRL (microanalysis and trace) but aptitude measures (questionnaires) continue to be widely used in medical education. A major co...
journal_title:Medical education
pub_type: 杂志文章
doi:10.1111/medu.14079
更新日期:2020-08-01 00:00:00
abstract::This study reports on the generalizability of different skills assessed in the oral certification examinations in Internal Medicine of the Royal College of Physicians and Surgeons of Canada. Assessments from the 1992 examination were examined prospectively to determine (i) inter-rater reliability, (ii) correlation fro...
journal_title:Medical education
pub_type: 杂志文章
doi:10.1111/j.1365-2923.1996.tb00718.x
更新日期:1996-01-01 00:00:00
abstract::Medical students are allocated little curriculum time for exposure to expert systems. ESTA, a computer model of an expert system, was developed to make best use of this time. The nature of the students' interaction with ESTA is described, and their reactions to the expert system concepts and the place of expert system...
journal_title:Medical education
pub_type: 杂志文章
doi:10.1111/j.1365-2923.1988.tb00418.x
更新日期:1988-03-01 00:00:00
abstract::Medical students on an in-patient service and residents working in an ambulatory care clinic have regularly evaluated their clinical tutors over the 5 years 1985-1989. Both groups of raters reliably and predictably evaluated their tutors and both emphasize between-tutor comparisons more than actual rating values for i...
journal_title:Medical education
pub_type: 杂志文章
doi:10.1111/j.1365-2923.1993.tb00228.x
更新日期:1993-01-01 00:00:00
abstract:CONTEXT:Academic journals represent shared spaces wherein the significance of thematic areas, methodologies and paradigms are debated and shaped through collective engagement. By studying journals in their historical and cultural contexts, the academic community can gain insight into the ways in which authors and audie...
journal_title:Medical education
pub_type: 历史文章,杂志文章,评审
doi:10.1111/medu.13349
更新日期:2017-09-01 00:00:00
abstract::This paper describes the development and structure of an Electronic Study Guide for Oncology (LETSGO) for undergraduate medical students. LETSGO is aimed at clinical students learning about cancer. The subject of the guide is breast cancer and learning objectives cover structure and function, behavioural science, publ...
journal_title:Medical education
pub_type: 杂志文章
doi:10.1111/j.1365-2923.1995.tb02860.x
更新日期:1995-11-01 00:00:00
abstract:CONTEXT:Critical reflection may improve health professionals' performance of the social roles of care (eg collaboration) in indeterminate zones of practice that are ambiguous, unique, unstable or value-conflicted. Research must explore critical reflection in practice and how it is developed. In this study, we explored ...
journal_title:Medical education
pub_type: 杂志文章
doi:10.1111/medu.14032
更新日期:2020-04-01 00:00:00
abstract:OBJECTIVE:To follow the progress of young female adolescents, as risk-taking standardised patients (SPs), and to monitor for adverse affects that role-playing may have on the adolescents. METHODS:A prospective design was used in which 11 female adolescents, aged 13-15 years, were recruited from 2 schools. The adolesce...
journal_title:Medical education
pub_type: 杂志文章
doi:10.1111/j.1365-2929.2005.02343.x
更新日期:2006-01-01 00:00:00
abstract::Although computer marking of MCQ papers is common practice and is popular because of its accuracy, speed and the fact that detailed statistical analysis can be carried out painlessly, there is still a major role for hand-scoring. A computer and computer time are not always immediately available and some form of data c...
journal_title:Medical education
pub_type: 杂志文章
doi:10.1111/j.1365-2923.1983.tb01111.x
更新日期:1983-03-01 00:00:00
abstract::This report describes the results of the project 'Assessment of Undergraduate Medical Education: Re-inventing the Wheel?' funded by the Nuffield Trust. The project was initiated in order to obtain information on current assessment practices in medical schools across the UK, to determine the extent of change as a conse...
journal_title:Medical education
pub_type: 杂志文章
doi:10.1046/j.1365-2923.2000.0340s1001.x
更新日期:2000-09-01 00:00:00
abstract:CONTEXT:Recent studies suggest that self-explanation (SE) while diagnosing cases fosters the development of clinical reasoning in medical students; however, the conditions that optimise the impact of SE remain unknown. The example-based learning framework justifies an exploration of students' use of their own SEs combi...
journal_title:Medical education
pub_type: 杂志文章,随机对照试验
doi:10.1111/medu.12623
更新日期:2015-02-01 00:00:00
abstract:INTRODUCTION:In the context of movement towards mandatory continuing dental education, this paper describes how a delayed postal questionnaire can be used in course evaluation. Specifically, the value of the questionnaire as a tool for assessing the impact of short course attendance on general dental practice is examin...
journal_title:Medical education
pub_type: 杂志文章
doi:10.1046/j.1365-2923.1999.00355.x
更新日期:1999-07-01 00:00:00
abstract::Teaching medical ethics in Manchester within the introductory course of obstetrics and gynaecology is a joint activity with the Centre for Social Ethics and Policy. This interdisciplinary teaching has evolved through lecture sessions with small-group discussions dealing with topics of interest in human reproduction. T...
journal_title:Medical education
pub_type: 杂志文章
doi:10.1111/j.1365-2923.1990.tb02670.x
更新日期:1990-11-01 00:00:00
abstract:CONTEXT:Considerable research has been conducted recently into the notion of patient-centred consulting. The primary goal of this approach is to establish a clear understanding of the patient's perspective on his or her problem, and to allow this understanding to inform both the explanation and planning stages of the c...
journal_title:Medical education
pub_type: 杂志文章
doi:10.1111/j.1365-2923.2007.02789.x
更新日期:2007-07-01 00:00:00
abstract::This paper describes a strategy for helping students to learn about laboratory and radiological investigations in diagnosis and management, and to make decisions about the use of investigations, taking into account such features as safety, patient comfort and cost. Learning takes place through the use of a programmed ...
journal_title:Medical education
pub_type: 杂志文章
doi:10.1111/j.1365-2923.1981.tb02310.x
更新日期:1981-01-01 00:00:00
abstract:CONTEXT:Authentic early experience (AEE) describes experiences provided to new medical students to undertake 'human contact' to enhance learning. Although the concept of AEE is not new, and was commonplace prior to the Flexner Report of 1910, little is known about how or why meaning and knowledge are constructed throug...
journal_title:Medical education
pub_type: 杂志文章
doi:10.1111/j.1365-2923.2012.04287.x
更新日期:2013-01-01 00:00:00
abstract::The present study was undertaken to evaluate the competence of rotating residents in handling clinical problems, falling under the purview of the major clinical disciplines, which they come across during their routine work. Three hundred and one rotating residents (55% of the total) who graduated in June 1981 from the...
journal_title:Medical education
pub_type: 杂志文章
doi:10.1111/j.1365-2923.1983.tb01124.x
更新日期:1983-11-01 00:00:00
abstract::Beginning medical students spend numerous hours every week attending basic science lectures and taking notes. Medical faculty often wonder whether they should give students pre-printed instructors' notes before lectures. Proponents of this strategy argue that provided notes enhance learning by facilitating the accurat...
journal_title:Medical education
pub_type: 杂志文章
doi:10.1046/j.1365-2923.2002.01167.x
更新日期:2002-04-01 00:00:00
abstract:OBJECTIVES:The goals of this study were three-fold: to explore the reasons why some clinical teachers regularly attend centralised faculty development activities; to compare their responses with those of colleagues who do not attend, and to learn how we can make faculty development programmes more pertinent to teachers...
journal_title:Medical education
pub_type: 杂志文章
doi:10.1111/j.1365-2923.2010.03746.x
更新日期:2010-09-01 00:00:00
abstract::A 63-item questionnaire on attitudes to psychosocial issues in medicine was administered to final-year students in the Faculties of Medicine (n = 104), Pharmacy (n = 57) and Arts and Social Sciences (n = 75) of the University of Benin. The responses given were analysed by the summation and Cornell scalogram techniques...
journal_title:Medical education
pub_type: 杂志文章
doi:10.1111/j.1365-2923.1995.tb02848.x
更新日期:1995-07-01 00:00:00
abstract::In 1978, the second-year pre-clinical Behavioural Sciences course at Monash University Medical School was restructured to improve monitoring of, and feedback on, the development of interpersonal relationships between individual students and individual old age pensioners they were studying. Results indicate that integr...
journal_title:Medical education
pub_type: 杂志文章
doi:10.1111/j.1365-2923.1981.tb02314.x
更新日期:1981-01-01 00:00:00
abstract:OBJECTIVE:To assess the relative effectiveness of videotape feedback and lecture methods for teaching alcohol brief intervention skills. DESIGN:In a controlled trial, two student blocks received a manual, lecture and demonstration about the principles and practice of brief alcohol intervention. In addition, experiment...
journal_title:Medical education
pub_type: 临床试验,杂志文章
doi:10.1046/j.1365-2923.1999.00378.x
更新日期:1999-08-01 00:00:00
abstract::The learning styles and preferences of health professionals have been studied increasingly over the past decade, yet few relationships have been found between doctors' career choices and learning styles. One of the problems of relating learning styles to specialty choice is that learning style instruments measure how ...
journal_title:Medical education
pub_type: 杂志文章
doi:10.1111/j.1365-2923.1987.tb00697.x
更新日期:1987-05-01 00:00:00
abstract:OBJECTIVE:This study sought to determine the relative contributions made by transferable skills and content-specific skills to Year 2 medical student performance in a clinical skills examination. METHODS:Correlated trait-correlated method models were constructed to describe the performance of 2 year groups of students...
journal_title:Medical education
pub_type: 杂志文章
doi:10.1111/j.1365-2923.2008.03020.x
更新日期:2008-06-01 00:00:00
abstract::The Wellcome Tropical Institute has assisted countries in the tropics to establish viable systems of continuing medical education, particularly for young doctors practising in rural areas. As part of this strategy the Institute has developed material for use in distance learning. The first attempt to apply the problem...
journal_title:Medical education
pub_type: 杂志文章
doi:10.1111/j.1365-2923.1992.tb00192.x
更新日期:1992-09-01 00:00:00