Abstract
BackgroundA key challenge clinicians face when considering differential diagnoses is whether the patient data have been adequately collected. Insufficient data may inadvertently lead to premature closure of the diagnostic process. This study aimed to test the hypothesis that the application of a mnemonic checklist helps to stimulate more patient data collection, thus leading to better diagnostic consideration.MethodsA total of 88 final year medical students were assigned to either an educational intervention group or a control group in a non-equivalent group post-test only design. Participants in the intervention group received a tutorial on the use of a mnemonic checklist aimed to minimize cognitive errors in clinical decision-making. Two weeks later, the participants in both groups were given a script concordance test consisting of 10 cases, with 3 items per case, to assess their clinical decisions when additional data are given in the case scenarios.ResultsThe Mann-Whitney U-test performed on the total scores from both groups showed no statistical significance (U = 792, z = −1.408, p = 0.159). When comparisons were made for the first half and the second half of the SCT, it was found that participants in the intervention group performed significantly better than participants in the control group in the first half of the test, with median scores of 9.15 (IQR 8.00–10.28) vs. 8.18 (IQR 7.16–9.24) respectively, U = 642.5, z = −2.661, p = 0.008. No significant difference was found in the second half of the test, with the median score of 9.58 (IQR 8.90–10.56) vs. 9.81 (IQR 8.83–11.12) for the intervention group and control group respectively (U = 897.5, z = −0.524, p = 0.60).ConclusionChecklist use in differential diagnoses consideration did show some benefit. However, this benefit seems to have been traded off by the time and effort in using it. More research is needed to determine whether this benefit could be translated into clinical practice after repetitive use.
Highlights
A key challenge clinicians face when considering differential diagnoses is whether the patient data have been adequately collected
Total test score group by acting as a self-regulatory prompt for a more careful consideration of the additional patient data, which in turn, may have resulted in the activation of additional illness scripts. This minimizes the risk of committing premature closure and seems to take more time. This is in keeping with the observation that participants in the TWED group outperformed those in the control group for the first half of the test scores, but not for the second half
Diagnostic error is a pervasive problem in clinical practice due to a number of causes including premature closure during the process of differential diagnoses consideration
Summary
A key challenge clinicians face when considering differential diagnoses is whether the patient data have been adequately collected. This study aimed to test the hypothesis that the application of a mnemonic checklist helps to stimulate more patient data collection, leading to better diagnostic consideration. One of the largest categories of diagnostic errors is cognitive errors [2]. These are due to one’s predisposition to think in a way that leads to errors in judgment [1, 3]. The process of generating differential diagnoses is said to typically occur in two interrelated steps [5, 6]. The first step typically occurs shortly upon encountering a patient and is called script activation. Scripts are prestored structured networks of knowledge that can be activated in working memory in a clinical encounter [5,6,7]
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