title: Why verifying diagnostic decisions with a checklist can help: insights from eye tracking.
abstract: Making a diagnosis involves ratifying or verifying a proposed answer. Formalizing this verification process with checklists, which highlight key variables involved in the diagnostic decision, is often advocated. However, the mechanisms by which a checklist might allow clinicians to improve their verification process have not been well studied. We hypothesize that using a checklist to verify diagnostic decisions enhances analytic scrutiny of key variables, thereby improving clinicians' ability to find and fix mistakes. We asked 16 participants to verify their interpretation of 12 electrocardiograms, randomly assigning half to be verified with a checklist and half with an analytic prompt. While participants were verifying their interpretation, we tracked their eye movements. We analyzed these eye movements using a series of eye tracking variables theoretically linked to analytic scrutiny of key variables. We found that more errors were corrected using a checklist compared to an analytic prompt (.27 ± .53 errors per ECG vs. .04 ± .43, F 1,15 = 8.1, p = .01, η (2) = .20). Checklist use was associated with enhanced analytic scrutiny in all eye tracking measures assessed (F 6,10 = 6.0, p = .02). In this experiment, using a key variable checklist to verify diagnostic decisions improved error detection. This benefit was associated with enhanced analytic scrutiny of those key variables as measured by eye tracking.
authors: Department of Medicine, McMaster University Hamilton General Hospital, McMaster Wing Room 600, 237 Barton St, Hamilton, ON, L8L2X2, Canada. mattsibbald@gmail.com.|Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, School of Health Professions Education, Maastricht University, Maastricht, The Netherlands. mattsibbald@gmail.com.
authors: Matthew
authors: M
authors: Sibbald
authors: Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, School of Health Professions Education, Maastricht University, Maastricht, The Netherlands.
authors: Anique B H
authors: AB
authors: de Bruin
authors: Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada.
authors: Eric
authors: E
authors: Yu
authors: Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, School of Health Professions Education, Maastricht University, Maastricht, The Netherlands.
authors: Jeroen J G
authors: JJ
authors: van Merrienboer
mesh_terms: D002309:Cardiology / Q000193:education*; D057189:Checklist; D002983:Clinical Competence; D003657:Decision Making; D003951:Diagnostic Errors / Q000517:prevention & control; D004503:Education, Medical, Graduate / Q000379:methods*; D004562:Electrocardiography; D005133:Eye Movements; D006801:Humans; D009864:Ontario
keywords: Checklists; Clinical reasoning; Cognitive load; ECG interpretation