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"Franz, Timothy M"
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Do physicians know when their diagnoses are correct? Implications for decision support and error reduction
This study explores the alignment between physicians' confidence in their diagnoses and the \"correctness\" of these diagnoses, as a function of clinical experience, and whether subjects were prone to over-or underconfidence.
Prospective, counterbalanced experimental design.
Laboratory study conducted under controlled conditions at three academic medical centers.
Seventy-two senior medical students, 72 senior medical residents, and 72 faculty internists.
We created highly detailed, 2-to 4-page synopses of 36 diagnostically challenging medical cases, each with a definitive correct diagnosis. Subjects generated a differential diagnosis for each of 9 assigned cases, and indicated their level of confidence in each diagnosis.
A differential was considered \"correct\" if the clinically true diagnosis was listed in that subject's hypothesis list. To assess confidence, subjects rated the likelihood that they would, at the time they generated the differential, seek assistance in reaching a diagnosis. Subjects' confidence and correctness were \"mildly\" aligned (kappa=.314 for all subjects, .285 for faculty, .227 for residents, and .349 for students). Residents were overconfident in 41% of cases where their confidence and correctness were not aligned, whereas faculty were overconfident in 36% of such cases and students in 25%.
Even experienced clinicians may be unaware of the correctness of their diagnoses at the time they make them. Medical decision support systems, and other interventions designed to reduce medical errors, cannot rely exclusively on clinicians' perceptions of their needs for such support.
Journal Article
Do Physicians Know When Their Diagnoses Are Correct?
Objective: This study explores the alignment between physicians' confidence in their diagnoses and the “correctness” of these diagnoses, as a function of clinical experience, and whether subjects were prone to over‐or underconfidence.
Design: Prospective, counterbalanced experimental design.
Setting: Laboratory study conducted under controlled conditions at three academic medical centers.
Participants: Seventy‐two senior medical students, 72 senior medical residents, and 72 faculty internists.
Intervention: We created highly detailed, 2‐to 4‐page synopses of 36 diagnostically challenging medical cases, each with a definitive correct diagnosis. Subjects generated a differential diagnosis for each of 9 assigned cases, and indicated their level of confidence in each diagnosis.
Measurements And Main Results: A differential was considered “correct” if the clinically true diagnosis was listed in that subject's hypothesis list. To assess confidence, subjects rated the likelihood that they would, at the time they generated the differential, seek assistance in reaching a diagnosis. Subjects' confidence and correctness were “mildly” aligned (κ=.314 for all subjects, .285 for faculty, .227 for residents, and .349 for students). Residents were overconfident in 41% of cases where their confidence and correctness were not aligned, whereas faculty were overconfident in 36% of such cases and students in 25%.
Conclusions: Even experienced clinicians may be unaware of the correctness of their diagnoses at the time they make them. Medical decision support systems, and other interventions designed to reduce medical errors, cannot rely exclusively on clinicians' perceptions of their needs for such support.
Journal Article
The Impact of an Interdisciplinary Learning Community Course on Pseudoscientific Reasoning in First-Year Science Students
This case study examined the development and evaluation of an interdisciplinary first-year learning community designed to stimulate scientific reasoning and critical thinking. Designed to serve the needs of scholarship students majoring in mathematics and natural sciences, the six-credit learning community course was writing-intensive and emphasized general scientific reasoning and critical thinking skills. Success of the course was measured using a pre-test/post-test design that assessed students' paranormal beliefs. Outcomes of the study indicated students' paranormal beliefs were significantly lower at the end of the semester than at the beginning, which was used as a surrogate measure of scientific reasoning that was directly relevant to course content. Supplementary analyses demonstrated that their (a) paranormal beliefs were significantly lower than other students and (b) students self-identified the importance of the scientific reasoning skills learned in the course without being prompted on their teacher course evaluations. The results of this study can inform the design of interdisciplinary, scientific reasoning courses.
Journal Article
Creating A Culture By Choice, Not A Culture By Default
[...]it's not only the look and feel of the organization, but more importantly, the quality of experience for those inside and outside. [...]their core assumptions, espoused values and artifacts have simply emerged over time without a real strategy. Wegmans Supermarket, whose business cards famously state \"Employees first, customers second,\" is an industry leader in employee training, career growth, retention, and local philanthropy.
Trade Publication Article
Different Approaches to Teaching the Mechanics of American Psychological Association Style
Students have to learn two distinctly different tasks when writing research papers: a) creating and organizing prose, and b) formatting a manuscript according to the nuances and mechanics of a pre-determined format, such as Modern Language Association (MLA) or American Psychological Association (APA) guidelines. Two studies examined different approaches for teaching the details of APA style, including: a template, a checklist, and a combined approach that used both the template and checklist. The results demonstrated that while each technique individually helped students to learn APA style, using both together appeared to provide the most help to students. (Contains 2 tables and 1 footnote.)
Journal Article