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首页> 外文期刊>BMC Medical Education >Contextual factors and clinical reasoning: differences in diagnostic and therapeutic reasoning in board certified versus resident physicians
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Contextual factors and clinical reasoning: differences in diagnostic and therapeutic reasoning in board certified versus resident physicians

机译：情境因素和临床推理：董事会认证和住院医师在诊断和治疗推理上的差异

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The impact of context on the complex process of clinical reasoning is not well understood. Using situated cognition as the theoretical framework and videos to provide the same contextual “stimulus” to all participants, we examined the relationship between specific contextual factors on diagnostic and therapeutic reasoning accuracy in board certified internists versus resident physicians. Each participant viewed three videotaped clinical encounters portraying common diagnoses in internal medicine. We explicitly modified the context to assess its impact on performance (patient and physician contextual factors). Patient contextual factors, including English as a second language and emotional volatility, were portrayed in the videos. Physician participant contextual factors were self-rated sleepiness and burnout.. The accuracy of diagnostic and therapeutic reasoning was compared with covariates using Fisher Exact, Mann-Whitney U tests and Spearman Rho’s correlations as appropriate. Fifteen board certified internists and 10 resident physicians participated from 2013 to 2014. Accuracy of diagnostic and therapeutic reasoning did not differ between groups despite residents reporting significantly higher rates of sleepiness (mean rank 20.45 vs 8.03, U?=?0.5, p?
机译：背景对临床推理的复杂过程的影响尚不清楚。使用情境认知作为理论框架，并通过视频向所有参与者提供相同的情境“刺激”，我们研究了董事会认可的内科医师与住院医师在诊断和治疗推理准确性方面的具体情境因素之间的关系。每个参与者观看了三个录像的临床遭遇，描绘了内科的常见诊断。我们明确修改了上下文，以评估其对性能的影响（患者和医生的上下文因素）。视频中描绘了患者的情境因素，包括英语作为第二语言和情绪波动。医师参加者的情境因素是自我评估的嗜睡和倦怠。使用适当的Fisher精确检验，Mann-Whitney U检验和Spearman Rho相关性，将诊断和治疗推理的准确性与协变量进行比较。从2013年到2014年，有15名获得董事会认证的内科医师和10名住院医师参加了试验。尽管居民报告的嗜睡率显着提高，但是两组之间的诊断和治疗推理的准确性没有差异（平均等级20.45 vs 8.03，U = 0.5，p = <？ .001）和倦怠（平均排名20.50 vs 8.00，U？=？0.0，p？

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