• D P Sklar, M Hauswald, and D R Johnson.
• Division of Emergency Medicine, University of New Mexico School of Medicine, Albuquerque 87131.
• Ann Emerg Med. 1991 Sep 1;20(9):987-91.

Study ObjectiveTo compare the diagnostic processes of experienced emergency physicians with those of novices.DesignProspective, convenience sample of patients.SettingEmergency department of a county university medical center in a large southwestern urban community.ParticipantsExperienced emergency physicians (attending and senior residents) and novice clinicians (junior residents and senior medical students).InterventionsParticipants developed initial diagnostic impressions after reviewing the chief complaint, nurse triage notes, and vital signs. Tests were then selected, and a final diagnostic impression was identified after results were known. Clinicians also marked a visual analog scale corresponding to their estimate that each diagnostic possibility was correct.ResultsExperienced physicians increased their certainty more than novices (P = .014). They deviated from a standard history-physical-laboratory sequence more often than novices (P = .008).ConclusionExpertise in medical decision making is characterized by a moderate initial level of certainty concerning a diagnosis that significantly increases as the experienced clinician follows a flexible strategy of testing to arrive at a final diagnosis.

17 keywords...

hide…