Elsevier

Annals of Emergency Medicine

Volume 20, Issue 9, September 1991, Pages 987-991
Annals of Emergency Medicine

Original contribution
Medical problem solving and uncertainty in the emergency department

https://doi.org/10.1016/S0196-0644(05)82977-4Get rights and content

Study objective:

To compare the diagnostic processes of experienced emergency physicians with those of novices.

Design:

Prospective, convenience sample of patients.

Setting:

Emergency department of a county university medical center in a large southwestern urban community.

Participants:

Experienced emergency physicians (attending and senior residents) and novice clinicians (junior residents and senior medical students).

Interventions:

Participants 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.

Results:

Experienced physicians increased their certainty more than novices (P = .014). They deviated from a standard history-physical-laboratory sequence more often than novices (P = .008).

Conclusion:

Expertise 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.

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