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The blind leading the blind…

Diagnostic Performance by Medical Students Working Individually or in Teams Hautz WE et al. JAMA 2015 313(3): 303-304


Reviewed by Joanna Holland

What was the study question?
Does diagnostic performance by medical students working in pairs differ from that of students working alone?

How was the study done?
This was a randomized study comparing diagnostic accuracy and several other aspects of clinical decision-making in 88 fourth year medical students randomized to work individually or in pairs at the Charite Medical School in Berlin, Germany. Students were asked to evaluate 6 simulated cases of respiratory distress on a computer. They were instructed to select as many tests as they wished from a list of 30 diagnostic tests, and to be as fast and accurate as possible. They were given the results of their selected tests, and then asked to select 1 of 20 diagnoses and indicate their confidence. Outcomes studied were diagnostic accuracy, number and relevance of diagnostic tests, time to diagnosis, time tests would have taken in reality, and students’ confidence in their diagnosis.

What were the results?
Students working in pairs were more accurate than individuals (67.78% vs. 50.00%), despite having comparable knowledge about the topic and selecting an equal number of diagnostic tests. Pairs took longer than individuals to reach a diagnosis during the assessment (4.27 minutes vs. 2.25 minutes per task) but the tests they selected would have taken less time in reality (31:11 minutes vs. 37.26 minutes). Students working in pairs were more confident in their diagnoses, regardless of whether those diagnoses were correct or incorrect.

What are the implications of these findings?
Diagnostic error is known to contribute substantially to preventable medical error. Working collaboratively can reduce diagnostic errors among medical students, perhaps by correcting errors, filling knowledge gaps and counteracting reasoning flaws.

What are the implications of these findings? (Reviewed by Gina Lowell)
Fourth year medical students may benefit from working collaboratively during training. Most fourth year electives do not explicitly pair students for the purpose of improving their diagnostic skills. In this study, pairing students specifically led to improved diagnostic accuracy and selection of relevant diagnostic tests. Improved confidence through collaboration may be an asset to these students who are preparing to enter residency. Fourth year courses designed to prepare students for residency (e.g. “boot camps”) could consider integrating the paired student method to augment students’ diagnostic skills.

Editors’ note: This study reminds us how important it is to teach students to work collaboratively and to create opportunities for them to work together and learn from each other. There are all sorts of ways that we can apply these findings to our clerkships - to improve diagnostic accuracy, promote collaboration, and encourage discussing cases together. This study also reminds us that the Editor has to be very careful when ok’ing articles for review (SLB).

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