Effects of the use of differential diagnosis checklist and general de-biasing checklist on diagnostic performance in comparison to intuitive diagnosis.

BACKGROUND: How clinicians conduct diagnostic reasoning is a major issue. AIM: To evaluate whether intuitive and analytic processes (differential diagnosis checklist, DDXC; general de-biasing checklist, GDBC) might improve diagnostic performance.
METHODS: We enrolled 188 medical students (4th-6th grades) who were divided into two groups and assigned the five cases scenarios. Group 1 (n = 91) were instructed to provide the three most likely diagnoses immediately after reading the scenarios (intuitive diagnosis), then after reading GDBC (diagnosis by GDBC), and finally, after reading DDXC (diagnosis by DDXC). Conversely, group 2 (n = 97) were instructed to provide intuitive diagnoses, by DDXC, and by GDBC.
RESULTS: Among the group 1, there was significant difference of total scores (p = 0.01 by ANOVA) between intuitive (8.25) and DDXC (8.77). Among the group 2, we noted significant difference of total scores (p = 0.001 by ANOVA) between intuitive (7.21) and DDXC (7.96). Among the difficult cases, the proportions of correct diagnosis increased after reading DDXC, although among the simple cases, the proportions of correct diagnosis decreased after reading DDXC.
CONCLUSION: The use of DDXC, not GDBC, may improve the diagnostic performance in difficult cases, while intuitive process may still be better for simpler cases.