Peer Discussion Decreases Practice Intensity and Increases Certainty in Clinical Decision-Making Among Internal Medicine Residents.
Journal
Journal of graduate medical education
ISSN: 1949-8357
Titre abrégé: J Grad Med Educ
Pays: United States
ID NLM: 101521733
Informations de publication
Date de publication:
Jun 2021
Jun 2021
Historique:
received:
20
08
2020
revised:
22
12
2020
revised:
22
02
2021
accepted:
01
03
2021
entrez:
28
6
2021
pubmed:
29
6
2021
medline:
29
7
2021
Statut:
ppublish
Résumé
Team-based decision-making has been shown to reduce diagnostic error, increase clinical certainty, and decrease adverse events. This study aimed to assess the effect of peer discussion on resident practice intensity (PI) and clinical certainty (CC). A vignette-based instrument was adapted to measure PI, defined as the likelihood of ordering additional diagnostic tests, consultations or empiric treatment, and CC. Internal medicine residents at 7 programs in the Philadelphia area from April 2018 to June 2019 were eligible for inclusion in the study. Participants formed groups and completed each item of the instrument individually and as a group with time for peer discussion in between individual and group responses. Predicted group PI and CC scores were compared with measured group PI and CC scores, respectively, using paired Sixty-nine groups participated in the study (response rate 34%, average group size 2.88). The measured group PI score (2.29, SD = 0.23) was significantly lower than the predicted group PI score (2.33, SD = 0.22) with a mean difference of 0.04 (SD = 0.10; 95% CI 0.02-0.07; In this multicenter study of resident PI, peer discussion reduced PI and increased CC more than would be expected from averaging group members' individual scores.
Sections du résumé
BACKGROUND
BACKGROUND
Team-based decision-making has been shown to reduce diagnostic error, increase clinical certainty, and decrease adverse events.
OBJECTIVE
OBJECTIVE
This study aimed to assess the effect of peer discussion on resident practice intensity (PI) and clinical certainty (CC).
METHODS
METHODS
A vignette-based instrument was adapted to measure PI, defined as the likelihood of ordering additional diagnostic tests, consultations or empiric treatment, and CC. Internal medicine residents at 7 programs in the Philadelphia area from April 2018 to June 2019 were eligible for inclusion in the study. Participants formed groups and completed each item of the instrument individually and as a group with time for peer discussion in between individual and group responses. Predicted group PI and CC scores were compared with measured group PI and CC scores, respectively, using paired
RESULTS
RESULTS
Sixty-nine groups participated in the study (response rate 34%, average group size 2.88). The measured group PI score (2.29, SD = 0.23) was significantly lower than the predicted group PI score (2.33, SD = 0.22) with a mean difference of 0.04 (SD = 0.10; 95% CI 0.02-0.07;
CONCLUSIONS
CONCLUSIONS
In this multicenter study of resident PI, peer discussion reduced PI and increased CC more than would be expected from averaging group members' individual scores.
Identifiants
pubmed: 34178262
doi: 10.4300/JGME-D-20-00948.1
pmc: PMC8207905
doi:
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
371-376Déclaration de conflit d'intérêts
Conflict of interest: The authors declare they have no competing interests.
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