Abstract:
IMPORTANCE:Little is known about the relationship between physicians' diagnostic accuracy and their confidence in that accuracy. OBJECTIVE:To evaluate how physicians' diagnostic calibration, defined as the relationship between diagnostic accuracy and confidence in that accuracy, changes with evolution of the diagnostic process and with increasing diagnostic difficulty of clinical case vignettes. DESIGN, SETTING, AND PARTICIPANTS:We recruited general internists from an online physician community and asked them to diagnose 4 previously validated case vignettes of variable difficulty (2 easier; 2 more difficult). Cases were presented in a web-based format and divided into 4 sequential phases simulating diagnosis evolution: history, physical examination, general diagnostic testing data, and definitive diagnostic testing. After each phase, physicians recorded 1 to 3 differential diagnoses and corresponding judgments of confidence. Before being presented with definitive diagnostic data, physicians were asked to identify additional resources they would require to diagnose each case (ie, additional tests, second opinions, curbside consultations, referrals, and reference materials). MAIN OUTCOMES AND MEASURES:Diagnostic accuracy (scored as 0 or 1), confidence in diagnostic accuracy (on a scale of 0-10), diagnostic calibration, and whether additional resources were requested (no or yes). RESULTS:A total of 118 physicians with broad geographical representation within the United States correctly diagnosed 55.3% of easier and 5.8% of more difficult cases (P < .001). Despite a large difference in diagnostic accuracy between easier and more difficult cases, the difference in confidence was relatively small (7.2 vs 6.4 out of 10, for easier and more difficult cases, respectively) (P < .001) and likely clinically insignificant. Overall, diagnostic calibration was worse for more difficult cases (P < .001) and characterized by overconfidence in accuracy. Higher confidence was related to decreased requests for additional diagnostic tests (P = .01); higher case difficulty was related to more requests for additional reference materials (P = .01). CONCLUSIONS AND RELEVANCE:Our study suggests that physicians' level of confidence may be relatively insensitive to both diagnostic accuracy and case difficulty. This mismatch might prevent physicians from reexamining difficult cases where their diagnosis may be incorrect.
journal_name
JAMA Intern Medjournal_title
JAMA internal medicineauthors
Meyer AN,Payne VL,Meeks DW,Rao R,Singh Hdoi
10.1001/jamainternmed.2013.10081subject
Has Abstractpub_date
2013-11-25 00:00:00pages
1952-8issue
21eissn
2168-6106issn
2168-6114pii
1731967journal_volume
173pub_type
杂志文章abstract:Importance:Every day in the United States, more than 200 people are murdered or assaulted with a firearm. Little research has considered the role of interpersonal ties in the pathways through which gun violence spreads. Objective:To evaluate the extent to which the people who will become subjects of gun violence can b...
journal_title:JAMA internal medicine
pub_type: 杂志文章
doi:10.1001/jamainternmed.2016.8245
更新日期:2017-03-01 00:00:00
abstract:IMPORTANCE:Myocardial infarction (MI) is an established risk factor for atrial fibrillation (AF). However, the extent to which AF is a risk factor for MI has not been investigated. OBJECTIVE:To examine the risk of incident MI associated with AF. DESIGN, SETTING, AND PARTICIPANTS:A prospective cohort of 23,928 partici...
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更新日期:2017-12-01 00:00:00
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pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1001/jamainternmed.2018.2317
更新日期:2018-07-01 00:00:00
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pub_type: 杂志文章,多中心研究
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doi:10.1001/jamainternmed.2013.232
更新日期:2013-05-27 00:00:00
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pub_type: 杂志文章,meta分析,评审
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更新日期:2016-12-01 00:00:00
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更新日期:2018-03-01 00:00:00
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pub_type: 杂志文章,多中心研究
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更新日期:2013-07-08 00:00:00
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更新日期:2020-10-01 00:00:00
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pub_type: 杂志文章,随机对照试验
doi:10.1001/jamainternmed.2015.3874
更新日期:2015-10-01 00:00:00
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pub_type: 杂志文章,meta分析
doi:10.1001/jamainternmed.2014.348
更新日期:2014-05-01 00:00:00
abstract:Importance:Lung cancer has become a leading cause of death among people living with human immunodeficiency virus (HIV) (PLWH). Over 40% of PLWH in the United States smoke cigarettes; HIV independently increases the risk of lung cancer. Objective:To project cumulative lung cancer mortality by smoking exposure among PLW...
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pub_type: 杂志文章
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更新日期:2017-11-01 00:00:00
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journal_title:JAMA internal medicine
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更新日期:2013-07-08 00:00:00
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更新日期:2015-01-01 00:00:00
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pub_type: 杂志文章
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更新日期:2013-06-24 00:00:00
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更新日期:2019-06-01 00:00:00
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pub_type: 杂志文章,随机对照试验
doi:10.1001/jamainternmed.2013.6883
更新日期:2013-07-22 00:00:00
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pub_type: 杂志文章
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更新日期:2019-10-28 00:00:00
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journal_title:JAMA internal medicine
pub_type: 杂志文章
doi:10.1001/jamainternmed.2014.3279
更新日期:2014-09-01 00:00:00
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pub_type: 杂志文章,评审
doi:10.1001/jamainternmed.2016.3212
更新日期:2016-09-01 00:00:00
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pub_type: 杂志文章,多中心研究
doi:10.1001/jamainternmed.2015.1674
更新日期:2015-07-01 00:00:00
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pub_type: 杂志文章,评审
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更新日期:2017-12-01 00:00:00
abstract:BACKGROUND:The benefit of blood transfusion in patients with myocardial infarction is controversial, and a possibility of harm exists. METHODS:A systematic search of studies published between January 1, 1966, and March 31, 2012, was conducted using MEDLINE, EMBASE, CINAHL, Scopus, Web of Science, and Cochrane Central ...
journal_title:JAMA internal medicine
pub_type: 杂志文章,meta分析
doi:10.1001/2013.jamainternmed.1001
更新日期:2013-01-28 00:00:00