title: Effect of supervised students' involvement on diagnostic accuracy in hospitalized medical patients--a prospective controlled study.
abstract: BACKGROUND
  During internships most medical students engage in history taking and physical examination during evaluation of hospitalized patients. However, the students' ability for pattern recognition is not as developed as in medical experts and complete history taking is often not repeated by an expert, so important clues may be missed. On the other hand, students' history taking is usually more extensive than experts' history taking and medical students discuss their findings with a Supervisor. Thus the effect of student involvement on diagnostic accuracy is unclear. We therefore compared the diagnostic accuracy for patients in the medical emergency department with and without student involvement in the evaluation process.
  
  
  RESULTS
  Patients in the medical emergency department were assigned to evaluation by either a supervised medical student or an emergency department physician. We only included patients who were admitted to our hospital and subsequently cared for by another medical team on the ward. We compared the working diagnosis from the emergency department with the discharge diagnosis. A total of 310 patients included in the study were cared for by 41 medical students and 21 emergency department physicians. The working diagnosis was changed in 22% of the patients evaluated by physicians evaluation and in 10% of the patients evaluated by supervised medical students (p = .006). There was no difference in the expenditures for diagnostic procedures, length of stay in the emergency department or patient comorbidity complexity level.
  
  
  CONCLUSIONS
  Involvement of closely supervised medical students in the evaluation process of hospitalized medical patients leads to an improved diagnostic accuracy compared to evaluation by an emergency department physician alone.
authors.affiliation: Medical School, University of Tuebingen, Tuebingen, Germany.
authors.forename: Dorothea Adelheid
authors.initials: DA
authors.lastname: Herter
authors.forename: Robert
authors.initials: R
authors.lastname: Wagner
authors.forename: Friederike
authors.initials: F
authors.lastname: Holderried
authors.forename: Yelena
authors.initials: Y
authors.lastname: Fenik
authors.forename: Reimer
authors.initials: R
authors.lastname: Riessen
authors.forename: Peter
authors.initials: P
authors.lastname: Weyrich
authors.forename: Nora
authors.initials: N
authors.lastname: Celebi
mesh_terms: D000328:Adult; D000368:Aged; D003142:Communication; D004504:Education, Medical, Undergraduate / Q000379:methods; D004630:Emergencies; D004636:Emergency Service, Hospital; D005260:Female; D006760:Hospitalization; D006801:Humans; D007297:Inpatients; D007396:Internship and Residency; D008297:Male; D008487:Medical History Taking / Q000379:methods; D008875:Middle Aged; D010808:Physical Examination; D011446:Prospective Studies; D015203:Reproducibility of Results; D013337:Students, Medical