Controlled trial using computerized feedback to improve physicians' diagnostic judgments.
The goal of this study was to test an innovative method to improve physicians' diagnostic judgments by integrating the use of a computer program (employing cognitive feedback to teach a clinical rule that predicts the probability of streptococcal pharyngitis), a traditional lecture, and periodic disease-prevalence reports. In a controlled trial using pre- and postintervention measures involving 885 patients, the authors compared the effects of the integrated method on the diagnostic judgments of seven experienced physicians at a university health service (from 1982 to 1985) with the effects of the lecture alone on the judgments of seven experienced physicians at a different university health service (1986 to 1987). The integrated method significantly improved the quality of the physicians' judgments as measured by calibration curves and Brier scores, and increased the level of agreement between the physicians' judgments and those made by the clinical prediction rule. The lecture alone produced less improvement in the quality of the physicians' judgments, and decreased the level of agreement with the rule. The authors conclude that this method, based on cognitive psychology, is a promising educational tool.
Poses
R M
RM
Division of General Medicine, Virginia Commonwealth University-Medical College of Virginia, Richmond 23298.
Cebul
R D
RD
Wigton
R S
RS
Centor
R M
RM
Collins
M
M
Fleischli
G
G
D003194:Computer-Assisted Instruction / Q000592:standards*; D003661:Decision Support Techniques; D004502:Education, Medical, Continuing / Q000379:methods* / Q000592:standards; D005069:Evaluation Studies as Topic; D005246:Feedback; D006801:Humans; D007600:Judgment; D010612:Pharyngitis / Q000175:diagnosis* / Q000453:epidemiology; D010820:Physicians / Q000523:psychology*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D013290:Streptococcal Infections / Q000175:diagnosis* / Q000453:epidemiology; D013333:Student Health Services