Evaluation of diagnostic accuracy in the clinical setting.

The admission diagnoses of 183 patients seen in the Emergency Room by 14 residents in surgery were compared with the discharge diagnoses of the same patients. The degree of accuracy of the admission diagnosis was rated by an experienced surgeon on a 0 to 4 scale for each patient, and the average diagnostic accuracy score was calculated for each resident. The residents' scores ranged from 2.0-3.3 (mean 2.6). The average diagnostic accuracy score was shown to be a discriminative measure. It correlated significantly with the quality of the initial diagnostic hypotheses, as measured by a written open-ended clinical simulation, but not with the success of the residents on the remaining parts of the written clinical simulation, with their peer and preceptor ratings, nor with the length of their training prior to testing.