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Investing in the use of a checklist during differential diagnoses consideration: what’s the trade-off?

机译：在进行差异诊断时要考虑使用检查表：有何权衡取舍？

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A 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. A 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. The 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). Checklist 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.
机译：临床医生在考虑鉴别诊断时面临的主要挑战是患者数据是否已被充分收集。数据不足可能会导致诊断过程过早关闭。这项研究旨在检验以下假设：助记符清单的应用有助于刺激更多的患者数据收集，从而带来更好的诊断考虑。在非等效组仅用于测试后的设计中，共有88名最后一年的医学生被分配到教育干预组或对照组。干预小组的参与者收到了有关使用记忆清单的教程，该清单旨在最大程度地减少临床决策中的认知错误。两周后，两组参与者均接受了由10例病例组成的脚本一致性测试，每例3项，以便在病例情况下提供其他数据时评估他们的临床决策。两组的总分进行的Mann-Whitney U检验均无统计学意义（U？=？792，z？=？1.408，p？=？0.159）。在对SCT的上半部分和下半部分进行比较时，发现在测试的上半部分，干预组的参与者的表现明显优于对照组，平均得分为9.15（IQR 8.00 –10.28）与8.18（IQR 7.16–9.24）分别为U？=？642.5，z？= ?? 2.661，p？=？0.008。在测试的后半段没有发现显着差异，干预组和对照组的中位数分别为9.58（IQR 8.90–10.56）与9.81（IQR 8.83–11.12）（U？=？897.5，z α＝Δ0.524，pα＝Δ0.60）。在差异诊断中考虑使用清单确实显示出一些好处。但是，这种好处似乎已经被使用它的时间和精力折衷了。需要更多的研究来确定重复使用后是否可以将这种益处转化为临床实践。

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