The biasing effect of clinical history on physical examination diagnostic accuracy

• Published in: Medical education 2011-08, Vol.45 (8), p.827-834
• Main Authors: Sibbald, Matthew, Cavalcanti, Rodrigo B
• Format: Article
• Language: English
• Subjects: Analysis of Variance; Biological and medical sciences; Clinical Competence - standards; Diagnosis, Differential; Diagnostic Errors - prevention & control; Education, Medical, Graduate - methods; Education, Medical, Graduate - standards; Health participants; Humans; Medical History Taking - methods; Medical History Taking - standards; Medical sciences; Miscellaneous; Physical Examination - standards; Public health. Hygiene; Public health. Hygiene-occupational medicine; Random Allocation; Teaching - methods
• ISSN: 0308-0110; 1365-2923
• DOI: 10.1111/j.1365-2923.2011.03997.x

Medical Education 2011:45: 827–834 Context  Literature on diagnostic test interpretation has shown that access to clinical history can both enhance diagnostic accuracy and increase diagnostic error. Knowledge of clinical history has also been shown to enhance the more complex cognitive task of physical examination diagnosis, possibly by enabling early hypothesis generation. However, it is unclear whether clinicians adhere to these early hypotheses in the face of unexpected physical findings, thus resulting in diagnostic error. Methods  A sample of 180 internal medicine residents received a short clinical history and conducted a cardiac physical examination on a high‐fidelity simulator. Resident Doctors (Residents) were randomised to three groups based on the physical findings in the simulator. The concordant group received physical examination findings consistent with the diagnosis that was most probable based on the clinical history. Discordant groups received findings associated with plausible alternative diagnoses which either lacked expected findings (indistinct discordant) or contained unexpected findings (distinct discordant). Physical examination diagnostic accuracy and physical examination findings were analysed. Results  Physical examination diagnostic accuracy varied significantly among groups (75 ± 44%, 2 ± 13% and 31 ± 47% in the concordant, indistinct discordant and distinct discordant groups, respectively (F2,177 = 53, p