Bayes' theorem and the physical examination: probability assessment and diagnostic decision making
To determine how examination findings influence the probability assessment and diagnostic decision making of third- and fourth-year medical students, internal medicine residents, and academic general internists. In a 2008 cross-sectional, Web-based survey, participants from three medical schools wer...
Gespeichert in:
| Veröffentlicht in: | Academic Medicine 2011-05, Vol.86 (5), p.618-627 |
|---|---|
| Hauptverfasser: | , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 627 |
|---|---|
| container_issue | 5 |
| container_start_page | 618 |
| container_title | Academic Medicine |
| container_volume | 86 |
| creator | Herrle, Scott R Corbett, Jr, Eugene C Fagan, Mark J Moore, Charity G Elnicki, D Michael |
| description | To determine how examination findings influence the probability assessment and diagnostic decision making of third- and fourth-year medical students, internal medicine residents, and academic general internists.
In a 2008 cross-sectional, Web-based survey, participants from three medical schools were asked questions about their training and eight examination scenarios representing four conditions. Participants were given literature-derived preexamination probabilities for each condition and were asked to (1) estimate postexamination probabilities (post-EPs) and (2) select a diagnostic choice (report that condition is present, order more tests, or report that condition is absent). Participants' inverse transformed logit (ITL) mean post-EPs were compared with corresponding literature-derived post-EPs.
Of 906 individuals invited to participate, 684 (75%) submitted a completed survey. In two of four scenarios with positive findings, the participants' ITL mean post-EPs were significantly less than corresponding literature-derived post-EP point estimates (P |
| doi_str_mv | 10.1097/ACM.0b013e318212eb00 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_3427763</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>879678939</sourcerecordid><originalsourceid>FETCH-LOGICAL-c407t-9bce31604e33ccfacb19ba8996e1f012bce176f885e14f21fecb4d5e39e7db4a3</originalsourceid><addsrcrecordid>eNpdUV1P3DAQtCqqQin_oKryxlPoOvb5g4dK9ERbJBAvrcSbtXY2dy5JfI1zVe_fYwpFlKcdaWdmZzWMvedwwsHqj2fLqxPwwAUJbhrekAd4xQ64FaY2YG72CgYJdSOl2mdvc_4JAEovxBu233AplFJwwPxn3FE-ruY1pYmGCsf2Hleb9S7HgH1Ff3CII84xjafVZkoefezjvKswZ8p5oHH-K2ojrsaU5xiqlkLMhV8NeBvH1Tv2usM-09HjPGQ_vpx_X36rL6-_XizPLusgQc-19aF8okCSECF0GDy3Ho21ingHvClrrlVnzIK47BreUfCyXZCwpFsvURyyTw--m60fqA0l2YS920xxwGnnEkb3_2aMa7dKv52QjdZKFIPjR4Mp_dpSnt0Qc6C-x5HSNjujrdLGCluY8oEZppTzRN3TFQ7uvh1X2nEv2ymyD88TPon-1SHuAH0vkCA</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>879678939</pqid></control><display><type>article</type><title>Bayes' theorem and the physical examination: probability assessment and diagnostic decision making</title><source>MEDLINE</source><source>Journals@Ovid LWW Legacy Archive</source><source>Alma/SFX Local Collection</source><creator>Herrle, Scott R ; Corbett, Jr, Eugene C ; Fagan, Mark J ; Moore, Charity G ; Elnicki, D Michael</creator><creatorcontrib>Herrle, Scott R ; Corbett, Jr, Eugene C ; Fagan, Mark J ; Moore, Charity G ; Elnicki, D Michael</creatorcontrib><description>To determine how examination findings influence the probability assessment and diagnostic decision making of third- and fourth-year medical students, internal medicine residents, and academic general internists.
In a 2008 cross-sectional, Web-based survey, participants from three medical schools were asked questions about their training and eight examination scenarios representing four conditions. Participants were given literature-derived preexamination probabilities for each condition and were asked to (1) estimate postexamination probabilities (post-EPs) and (2) select a diagnostic choice (report that condition is present, order more tests, or report that condition is absent). Participants' inverse transformed logit (ITL) mean post-EPs were compared with corresponding literature-derived post-EPs.
Of 906 individuals invited to participate, 684 (75%) submitted a completed survey. In two of four scenarios with positive findings, the participants' ITL mean post-EPs were significantly less than corresponding literature-derived post-EP point estimates (P<.001 for each). In three of four scenarios with negative findings, ITL mean post-EPs were significantly greater than corresponding literature-derived post-EP point estimates (P<.001 for each). In the four scenarios with positive findings, 17% to 38% of participants ordered more diagnostic tests when the literature indicated a >85% probability that the condition was present. In the four scenarios with largely negative findings, 70% to 85% chose to order diagnostic tests to further reduce diagnostic uncertainty.
All three groups tended to similarly underestimate the impact of examination findings on condition probability assessment, especially negative findings, and often ordered more tests when probabilities indicated that additional testing was unnecessary.</description><identifier>ISSN: 1040-2446</identifier><identifier>EISSN: 1938-808X</identifier><identifier>DOI: 10.1097/ACM.0b013e318212eb00</identifier><identifier>PMID: 21436660</identifier><language>eng</language><publisher>United States</publisher><subject>Adult ; Bayes Theorem ; Cross-Sectional Studies ; Decision Making ; Diagnosis, Differential ; Diagnostic Tests, Routine - standards ; Diagnostic Tests, Routine - trends ; Female ; Humans ; Internship and Residency - statistics & numerical data ; Male ; Medical Staff, Hospital - statistics & numerical data ; Middle Aged ; Physical Examination - standards ; Physical Examination - trends ; Pilot Projects ; Probability ; Students, Medical - statistics & numerical data ; United States ; Young Adult</subject><ispartof>Academic Medicine, 2011-05, Vol.86 (5), p.618-627</ispartof><rights>Copyright © by the Association of American medical Colleges.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c407t-9bce31604e33ccfacb19ba8996e1f012bce176f885e14f21fecb4d5e39e7db4a3</citedby><cites>FETCH-LOGICAL-c407t-9bce31604e33ccfacb19ba8996e1f012bce176f885e14f21fecb4d5e39e7db4a3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,777,781,882,27905,27906</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21436660$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Herrle, Scott R</creatorcontrib><creatorcontrib>Corbett, Jr, Eugene C</creatorcontrib><creatorcontrib>Fagan, Mark J</creatorcontrib><creatorcontrib>Moore, Charity G</creatorcontrib><creatorcontrib>Elnicki, D Michael</creatorcontrib><title>Bayes' theorem and the physical examination: probability assessment and diagnostic decision making</title><title>Academic Medicine</title><addtitle>Acad Med</addtitle><description>To determine how examination findings influence the probability assessment and diagnostic decision making of third- and fourth-year medical students, internal medicine residents, and academic general internists.
In a 2008 cross-sectional, Web-based survey, participants from three medical schools were asked questions about their training and eight examination scenarios representing four conditions. Participants were given literature-derived preexamination probabilities for each condition and were asked to (1) estimate postexamination probabilities (post-EPs) and (2) select a diagnostic choice (report that condition is present, order more tests, or report that condition is absent). Participants' inverse transformed logit (ITL) mean post-EPs were compared with corresponding literature-derived post-EPs.
Of 906 individuals invited to participate, 684 (75%) submitted a completed survey. In two of four scenarios with positive findings, the participants' ITL mean post-EPs were significantly less than corresponding literature-derived post-EP point estimates (P<.001 for each). In three of four scenarios with negative findings, ITL mean post-EPs were significantly greater than corresponding literature-derived post-EP point estimates (P<.001 for each). In the four scenarios with positive findings, 17% to 38% of participants ordered more diagnostic tests when the literature indicated a >85% probability that the condition was present. In the four scenarios with largely negative findings, 70% to 85% chose to order diagnostic tests to further reduce diagnostic uncertainty.
All three groups tended to similarly underestimate the impact of examination findings on condition probability assessment, especially negative findings, and often ordered more tests when probabilities indicated that additional testing was unnecessary.</description><subject>Adult</subject><subject>Bayes Theorem</subject><subject>Cross-Sectional Studies</subject><subject>Decision Making</subject><subject>Diagnosis, Differential</subject><subject>Diagnostic Tests, Routine - standards</subject><subject>Diagnostic Tests, Routine - trends</subject><subject>Female</subject><subject>Humans</subject><subject>Internship and Residency - statistics & numerical data</subject><subject>Male</subject><subject>Medical Staff, Hospital - statistics & numerical data</subject><subject>Middle Aged</subject><subject>Physical Examination - standards</subject><subject>Physical Examination - trends</subject><subject>Pilot Projects</subject><subject>Probability</subject><subject>Students, Medical - statistics & numerical data</subject><subject>United States</subject><subject>Young Adult</subject><issn>1040-2446</issn><issn>1938-808X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdUV1P3DAQtCqqQin_oKryxlPoOvb5g4dK9ERbJBAvrcSbtXY2dy5JfI1zVe_fYwpFlKcdaWdmZzWMvedwwsHqj2fLqxPwwAUJbhrekAd4xQ64FaY2YG72CgYJdSOl2mdvc_4JAEovxBu233AplFJwwPxn3FE-ruY1pYmGCsf2Hleb9S7HgH1Ff3CII84xjafVZkoefezjvKswZ8p5oHH-K2ojrsaU5xiqlkLMhV8NeBvH1Tv2usM-09HjPGQ_vpx_X36rL6-_XizPLusgQc-19aF8okCSECF0GDy3Ho21ingHvClrrlVnzIK47BreUfCyXZCwpFsvURyyTw--m60fqA0l2YS920xxwGnnEkb3_2aMa7dKv52QjdZKFIPjR4Mp_dpSnt0Qc6C-x5HSNjujrdLGCluY8oEZppTzRN3TFQ7uvh1X2nEv2ymyD88TPon-1SHuAH0vkCA</recordid><startdate>20110501</startdate><enddate>20110501</enddate><creator>Herrle, Scott R</creator><creator>Corbett, Jr, Eugene C</creator><creator>Fagan, Mark J</creator><creator>Moore, Charity G</creator><creator>Elnicki, D Michael</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20110501</creationdate><title>Bayes' theorem and the physical examination: probability assessment and diagnostic decision making</title><author>Herrle, Scott R ; Corbett, Jr, Eugene C ; Fagan, Mark J ; Moore, Charity G ; Elnicki, D Michael</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c407t-9bce31604e33ccfacb19ba8996e1f012bce176f885e14f21fecb4d5e39e7db4a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>Adult</topic><topic>Bayes Theorem</topic><topic>Cross-Sectional Studies</topic><topic>Decision Making</topic><topic>Diagnosis, Differential</topic><topic>Diagnostic Tests, Routine - standards</topic><topic>Diagnostic Tests, Routine - trends</topic><topic>Female</topic><topic>Humans</topic><topic>Internship and Residency - statistics & numerical data</topic><topic>Male</topic><topic>Medical Staff, Hospital - statistics & numerical data</topic><topic>Middle Aged</topic><topic>Physical Examination - standards</topic><topic>Physical Examination - trends</topic><topic>Pilot Projects</topic><topic>Probability</topic><topic>Students, Medical - statistics & numerical data</topic><topic>United States</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Herrle, Scott R</creatorcontrib><creatorcontrib>Corbett, Jr, Eugene C</creatorcontrib><creatorcontrib>Fagan, Mark J</creatorcontrib><creatorcontrib>Moore, Charity G</creatorcontrib><creatorcontrib>Elnicki, D Michael</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Academic Medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Herrle, Scott R</au><au>Corbett, Jr, Eugene C</au><au>Fagan, Mark J</au><au>Moore, Charity G</au><au>Elnicki, D Michael</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Bayes' theorem and the physical examination: probability assessment and diagnostic decision making</atitle><jtitle>Academic Medicine</jtitle><addtitle>Acad Med</addtitle><date>2011-05-01</date><risdate>2011</risdate><volume>86</volume><issue>5</issue><spage>618</spage><epage>627</epage><pages>618-627</pages><issn>1040-2446</issn><eissn>1938-808X</eissn><abstract>To determine how examination findings influence the probability assessment and diagnostic decision making of third- and fourth-year medical students, internal medicine residents, and academic general internists.
In a 2008 cross-sectional, Web-based survey, participants from three medical schools were asked questions about their training and eight examination scenarios representing four conditions. Participants were given literature-derived preexamination probabilities for each condition and were asked to (1) estimate postexamination probabilities (post-EPs) and (2) select a diagnostic choice (report that condition is present, order more tests, or report that condition is absent). Participants' inverse transformed logit (ITL) mean post-EPs were compared with corresponding literature-derived post-EPs.
Of 906 individuals invited to participate, 684 (75%) submitted a completed survey. In two of four scenarios with positive findings, the participants' ITL mean post-EPs were significantly less than corresponding literature-derived post-EP point estimates (P<.001 for each). In three of four scenarios with negative findings, ITL mean post-EPs were significantly greater than corresponding literature-derived post-EP point estimates (P<.001 for each). In the four scenarios with positive findings, 17% to 38% of participants ordered more diagnostic tests when the literature indicated a >85% probability that the condition was present. In the four scenarios with largely negative findings, 70% to 85% chose to order diagnostic tests to further reduce diagnostic uncertainty.
All three groups tended to similarly underestimate the impact of examination findings on condition probability assessment, especially negative findings, and often ordered more tests when probabilities indicated that additional testing was unnecessary.</abstract><cop>United States</cop><pmid>21436660</pmid><doi>10.1097/ACM.0b013e318212eb00</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1040-2446 |
| ispartof | Academic Medicine, 2011-05, Vol.86 (5), p.618-627 |
| issn | 1040-2446 1938-808X |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_3427763 |
| source | MEDLINE; Journals@Ovid LWW Legacy Archive; Alma/SFX Local Collection |
| subjects | Adult Bayes Theorem Cross-Sectional Studies Decision Making Diagnosis, Differential Diagnostic Tests, Routine - standards Diagnostic Tests, Routine - trends Female Humans Internship and Residency - statistics & numerical data Male Medical Staff, Hospital - statistics & numerical data Middle Aged Physical Examination - standards Physical Examination - trends Pilot Projects Probability Students, Medical - statistics & numerical data United States Young Adult |
| title | Bayes' theorem and the physical examination: probability assessment and diagnostic decision making |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-21T08%3A10%3A40IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Bayes'%20theorem%20and%20the%20physical%20examination:%20probability%20assessment%20and%20diagnostic%20decision%20making&rft.jtitle=Academic%20Medicine&rft.au=Herrle,%20Scott%20R&rft.date=2011-05-01&rft.volume=86&rft.issue=5&rft.spage=618&rft.epage=627&rft.pages=618-627&rft.issn=1040-2446&rft.eissn=1938-808X&rft_id=info:doi/10.1097/ACM.0b013e318212eb00&rft_dat=%3Cproquest_pubme%3E879678939%3C/proquest_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=879678939&rft_id=info:pmid/21436660&rfr_iscdi=true |