Med Decis Making - A balance beam aid for instruction in clinical diagnostic reasoning.

Tópicos

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Resumo

We describe a balance beam aid for instruction in diagnosis (BBAID) and demonstrate its potential use in supplementing the training of medical students to diagnose acute chest pain. We suggest the BBAID helps students understand the process of diagnosis because the impact of tokens (weights and helium balloons) attached to a beam at different distances from the fulcrum is analogous to the impact of evidence to the relative support for 2 diseases. The BBAID presents a list of potential findings and allows students to specify whether each is present, absent, or unknown. It displays the likelihood ratios corresponding to a positive (LR+) or negative (LR-) observation for each symptom, for any pair of diseases. For each specified finding, a token is placed on the beam at a location whose distance from the fulcrum is proportional to the finding's log(LR): a downward force (a weight) if the finding is present and a lifting force (a balloon) if it is absent. Combining the physical torques of multiple tokens is mathematically identical to applying Bayes' theorem to multiple independent findings, so the balance beam is a high-fidelity metaphor. Seven first-year medical students and 3 faculty members consulted the BBAID while diagnosing brief patient case vignettes. Student comments indicated the program is usable, helpful for understanding pertinent positive and negative findings' usefulness in particular situations, and welcome as a reference or self-test. All students attended the effect of the tokens on the beam, although some stated they did not use the numerical statistics. Faculty noted the BBAID might be particularly helpful in reminding students of diseases that should not be missed and identifying pertinent findings to ask for.

Resumo Limpo

describ balanc beam aid instruct diagnosi bbaid demonstr potenti use supplement train medic student diagnos acut chest pain suggest bbaid help student understand process diagnosi impact token weight helium balloon attach beam differ distanc fulcrum analog impact evid relat support diseas bbaid present list potenti find allow student specifi whether present absent unknown display likelihood ratio correspond posit lr negat lr observ symptom pair diseas specifi find token place beam locat whose distanc fulcrum proport find loglr downward forc weight find present lift forc balloon absent combin physic torqu multipl token mathemat ident appli bay theorem multipl independ find balanc beam highfidel metaphor seven firstyear medic student faculti member consult bbaid diagnos brief patient case vignett student comment indic program usabl help understand pertin posit negat find use particular situat welcom refer selftest student attend effect token beam although state use numer statist faculti note bbaid might particular help remind student diseas miss identifi pertin find ask

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