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Effect of stress on clinical reasoning during simulated ambulatory consultations

机译：模拟门诊咨询过程中压力对临床推理的影响

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Background: The goal of this study was to examine the impact of subjective and physiological stress responses on medical students' diagnostic reasoning and communication skills. Method: A prospective randomized quantitative study was undertaken, looking at ambulatory consultations in internal medicine. On the first day (baseline day), volunteer year 6 students (n=41) participated in a simulated ambulatory consultation with standardized patients (SPs). On the second day (study day), one week later, they were randomly assigned to two groups: a low stress (n=20) and a high stress (n=21) simulated ambulatory consultation. Stress was measured using validated questionnaires and salivary cortisol. The SPs assessed the students' reasoning and communication. The students completed assessments of their clinical reasoning after the consultations. Results: Although stress measures were all significantly higher in the high-stress condition (all p<0.05), no differences were found in diagnostic accuracy and justification scores. However, correlational analyses revealed a negative correlation between multiple-stress measures and the students' ability to generate arguments for differential diagnoses. Conclusion: Stress was associated with impairments in clinical reasoning, of a nature typically suggestive of premature closure.
机译：背景：本研究的目的是研究主观和生理压力反应对医学生诊断推理和沟通技巧的影响。方法：进行一项前瞻性随机定量研究，研究内科的门诊咨询。在第一天（基准日），六年级志愿者（n = 41）参加了标准化患者（SP）的模拟门诊咨询。一周后的第二天（学习日），他们被随机分为两组：低压力（n = 20）和高压力（n = 21）模拟门诊。使用经过验证的问卷和唾液皮质醇测量压力。 SP评估了学生的推理和沟通能力。咨询后，学生完成了对其临床推理的评估。结果：尽管在高压力条件下压力措施均显着较高（所有p <0.05），但在诊断准确性和合理性评分上均无差异。但是，相关分析显示，多重压力测量与学生产生差异诊断的论据之间存在负相关。结论：压力与临床推理障碍有关，通常暗示过早关闭。

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