21 Jan Working In Pairs Improved Medical Students’ Diagnostic Accuracy
Medical Research: What is the background for this study? What are the main findings?
Dr. Kämmer: Diagnostic errors contribute substantially to preventable medical error. Of the multiple reasons for diagnostic error (such as technical failures or poorly cooperating patients), cognitive error is among the most frequent. Although a vast amount of literature explores ways to reduce cognitive errors, for example, during data synthesis, the collaborative character of clinical decision making has been largely neglected so far. Thus, the aim of our study was to investigate the effect of working in teams as opposed to working alone on diagnostic accuracy and the diagnostic decision process as such (including the time to diagnosis, number of ordered diagnostic tests and calibration of diagnostic confidence to diagnostic accuracy).
In our study, we asked senior medical students to imagine being at the emergency ward and having to diagnose six simulated patients with respiratory distress on a computer – either working individually or in pairs. We indeed found that working in pairs reduced diagnostic error without requiring more diagnostic data gathering. Interestingly, neither differences in knowledge nor in amount and relevance of acquired diagnostic information could explain the superior accuracy of the pairs; neither did the statistically increased likelihood of containing a knowledgeable member. We thus have shown that – similar to other studies outside medicine – collaboration may help correct errors, fill knowledge gaps and counteract reasoning flaws – and thus save lives. Moreover, we found that reflecting on their personal confidence may point members of teams towards an increased probability of a diagnostic error.
Medical Research: What should clinicians and patients take away from your report?
Dr. Kämmer: One result of our study was that pairs differed in their confidence in diagnoses more when being incorrect than when being correct. It would be thus interesting to further study whether this difference in confidence could be deliberatively used by members of a team as an indicator for incorrect diagnoses in order to further reduce diagnostic error. Also, future studies should validate our findings with real patients and senior physicians.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Kämmer: Collaboration among physicians may help reduce diagnostic errors and should thus be encouraged in the daily routine at hospitals.