title: Consistency in diagnostic suggestions does not influence the tendency to accept them.
abstract: BACKGROUND
  Studies suggest that residents tend to accept diagnostic suggestions, which could lead to diagnostic errors if the suggestion is incorrect. Those studies did not take into account that physicians in clinical practice will mainly encounter correct suggestions. The present study investigated residents' diagnostic performance if they would first encounter a number of correct suggestions followed by a number of incorrect suggestions, and vice versa. It was hypothesized that more incorrect suggestions would be accepted if participants had first evaluated a series of correct suggestions.
  
  
  METHODS
  Residents (n = 38) evaluated suggested diagnoses on eight written clinical cases. Half of the participants first evaluated four correct suggestions and then evaluated four incorrect suggestions (C/I condition). The other half started with the four incorrect suggestions followed by the correct suggestions (I/C condition).
  
  
  RESULTS
  Our findings show that the evaluation score in the C/I condition (M = 2.87, MSE = 0.14) equaled that in the I/C condition (M = 2.66, MSE = 0.14), F(1,36) = 1.09, p = 0.30, ns, meaning that consistency in preceding suggested diagnoses did not influence the tendency to accept subsequent diagnostic suggestions. There was, however, a significant interaction effect between case order and phase, F(1,36) = 11.82, p = 0.001, η p (2) = 0.25, demonstrating that the score on cases with correct suggestions was higher than the score on cases with incorrect suggestions.
  
  
  CONCLUSIONS
  These findings indicate that consistency in preceding correct or incorrect diagnostic suggestions did not influence the tendency to accept or reject subsequent suggestions. However, overall residents still showed a tendency to accept diagnostic suggestions, which may lead to diagnostic errors if the suggestion is incorrect.
authors.affiliation: Department of Internal Medicine, Erasmus Medical Centre, Rotterdam, the Netherlands.
authors.forename: Kees
authors.initials: K
authors.lastname: van den Berge
authors.affiliation: Department of Internal Medicine, Erasmus Medical Centre, Rotterdam, the Netherlands ; Department of Psychology, Erasmus University Rotterdam, Rotterdam, the Netherlands.
authors.forename: Silvia
authors.initials: S
authors.lastname: Mamede
authors.affiliation: Department of Psychology, Erasmus University Rotterdam, Rotterdam, the Netherlands.
authors.forename: Tamara
authors.initials: T
authors.lastname: van Gog
authors.affiliation: Department of Internal Medicine, Erasmus Medical Centre, Rotterdam, the Netherlands.
authors.forename: Jan
authors.initials: J
authors.lastname: van Saase
authors.affiliation: Department of Psychology, Erasmus University Rotterdam, Rotterdam, the Netherlands.
authors.forename: Remy
authors.initials: R
authors.lastname: Rikers