The influence of experience with a set of simulated patients on diagnosis of simulated patients not previously diagnosed.
OBJECTIVE
Diagnoses, to be useful, should be accurate. The purpose of this study using fictitious patients and student judges was to test the theory that diagnostic errors would occur when students saw simulated patients who were similar to previously seen simulated patients.


METHODS
Sixty physical therapist (PT) students and 60 non-physical therapist (NPT) students were studied. Subjects were assigned randomly to one of three groups.


METHODS
Instructions to the three groups differed in terms of rules provided for diagnoses and instructions to remember the patients. Students first diagnosed the same eight fictitious patients five times. The students then diagnosed eight new patients with similar characteristics interspersed with the original eight patients. Half of the new patients had a diagnosis different from that of the most similar old patient.


RESULTS
Students who were given a rule for diagnosis made fewer errors than students who were not given a rule. Students in the PT group took longer but made fewer errors on the critical opposite-diagnosis new cases than did students in the NPT group.


CONCLUSIONS
The results do not provide support for the theory that diagnostic errors would occur when students saw patients who were similar to previously seen patients. Students in the PT group appeared to emphasize accuracy at the expense of speed in making their diagnoses. Given the nature of the simulated patient information and the mode of presentation used in the experiment, however, the conclusion that therapists in actual practice do not make errors because of the similarity between new and previously seen patients is not yet warranted.
Norton
B J
BJ
Program in Physical Therapy, Washington University School of Medicine, St Louis, MO 63108, USA. nortonb@medicine.wustl.edu
Strube
M J
MJ
D000328:Adult; D002983:Clinical Competence; D003194:Computer-Assisted Instruction; D003661:Decision Support Techniques; D003951:Diagnostic Errors; D005260:Female; D006801:Humans; D008297:Male; D016544:Patient Simulation; D026741:Physical Therapy Modalities / Q000193:education*; D013336:Students, Health Occupations / Q000523:psychology*; D013997:Time Factors