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J Grad Med Educ. 2012 Jun;4(2):227-31. doi: 10.4300/JGME-D-11-00180.1.

Impact of a computer-based diagnostic decision support tool on the differential diagnoses of medicine residents.

Abstract

BACKGROUND:

Computer-based medical diagnostic decision support systems have been used for decades, initially as stand-alone applications. More recent versions have been tested for their effectiveness in enhancing the diagnostic ability of clinicians.

OBJECTIVE:

To determine if viewing a rank-ordered list of diagnostic possibilities from a medical diagnostic decision support system improves residents' differential diagnoses or management plans.

METHOD:

Twenty first-year internal medicine residents at Massachusetts General Hospital viewed 3 deidentified case descriptions of real patients. All residents completed a web-based questionnaire, entering the differential diagnosis and management plan before and after seeing the diagnostic decision support system's suggested list of diseases. In all 3 exercises, the actual case diagnosis was first on the system's list. Each resident served as his or her own control (pretest/posttest).

RESULTS:

For all 3 cases, a substantial percentage of residents changed their primary considered diagnosis after reviewing the system's suggested diagnoses, and a number of residents who had not initially listed a "further action" (laboratory test, imaging study, or referral) added or changed their management options after using the system. Many residents (20% to 65% depending on the case) improved their differential diagnosis from before to after viewing the system's suggestions. The average time to complete all 3 cases was 15.4 minutes. Most residents thought that viewing the medical diagnostic decision support system's list of suggestions was helpful.

CONCLUSION:

Viewing a rank-ordered list of diagnostic possibilities from a diagnostic decision support tool had a significant beneficial effect on the quality of first-year medicine residents' differential diagnoses and management plans.

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