Neha Bansal Etherington1, Caitlin Clancy2, R Benson Jones3, C Jessica Dine4, Gretchen Diemer5. 1. is Assistant Professor of Clinical Medicine and Director of the Internal Medicine Sub-Internship, Lewis Katz School of Medicine, Temple University, Division of Hospital Medicine, Temple University Health System. 2. is Instructor of Clinical Medicine, Division of Pulmonary, Allergy and Critical Care, University of Pennsylvania Health System, Perelman School of Medicine, University of Pennsylvania. 3. is a Fellow, Division of Endocrinology, Diabetes, and Metabolism, University of Pennsylvania Health System. 4. is Associate Professor of Medicine, Division of Pulmonary, Allergy and Critical Care, University of Pennsylvania Health System, and Associate Dean of Faculty Development, Perelman School of Medicine, Leonard Davis Institute of Health Economics, University of Pennsylvania. 5. is Professor of Medicine, Vice Chair of Education for Medicine, and Senior Associate Dean of Graduate Medical Education and Affiliations, Sidney Kimmel Medical College, Thomas Jefferson University.
Abstract
BACKGROUND: Team-based decision-making has been shown to reduce diagnostic error, increase clinical certainty, and decrease adverse events. OBJECTIVE: This study aimed to assess the effect of peer discussion on resident practice intensity (PI) and clinical certainty (CC). 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 t testing. 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; P = .0002). The measured group CC score (0.493, SD = 0.164) was significantly higher than the predicted group CC score (0.475, SD = 0.136) with a mean difference of 0.018 (SD = 0.073; 95% CI 0.0006-0.0356; P = .022). 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.
BACKGROUND: Team-based decision-making has been shown to reduce diagnostic error, increase clinical certainty, and decrease adverse events. OBJECTIVE: This study aimed to assess the effect of peer discussion on resident practice intensity (PI) and clinical certainty (CC). 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 t testing. 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; P = .0002). The measured group CC score (0.493, SD = 0.164) was significantly higher than the predicted group CC score (0.475, SD = 0.136) with a mean difference of 0.018 (SD = 0.073; 95% CI 0.0006-0.0356; P = .022). 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.
Authors: C Jessica Dine; Lisa M Bellini; Gretchen Diemer; Allison Ferris; Ashish Rana; Gina Simoncini; William Surkis; Charles Rothschild; David A Asch; Judy A Shea; Andrew J Epstein Journal: J Grad Med Educ Date: 2015-12
Authors: Ralf H J M Kurvers; Stefan M Herzog; Ralph Hertwig; Jens Krause; Patricia A Carney; Andy Bogart; Giuseppe Argenziano; Iris Zalaudek; Max Wolf Journal: Proc Natl Acad Sci U S A Date: 2016-07-18 Impact factor: 11.205
Authors: Juliane E Kämmer; Wolf E Hautz; Stefan M Herzog; Olga Kunina-Habenicht; Ralf H J M Kurvers Journal: Med Decis Making Date: 2017-03-29 Impact factor: 2.583