Table 1.
Characteristics of The Encounters, According to Clinical Experience*
| Experts 41 encounters | Residents 42 encounters | Students 42 encounters | Experience effect (P*) | Case effect (P*) | |
|---|---|---|---|---|---|
| Information collected | |||||
| Encounter duration, mean/case (minutes) | 15.2 (13.8 to 16.7) | 19.0 (18.0 to 19.9) | 21.4 (19.6 to 23.3) | .03 | .90 |
| Unique findings collected, mean N/case | 61 (56 to 67) | 77 (72 to 83) | 73 (67 to 79) | .19 | .62 |
| Relevance score† of unique findings, mean/case | 0.60 (0.57 to 0.62) | 0.41 (0.40 to 0.42) | 0.43 (0.41 to 0.44) | <.0001 | .68 |
| Key questions†, mean N/case | 9 (8 to 10) | 8 (7 to 8) | 7 (6 to 8) | <.0001 | <.0001 |
| Summary occurrences, mean N/case | 1.93 (1.63 to 2.22) | 1.38 (1.07 to 1.69) | 1.17 (.88 to 1.46) | .11 | .59 |
| Systems explored‡ | |||||
| Body systems explored; mean N/case | 7.4 (6.9 to 8.0) | 7.4 (6.8 to 7.9) | 6.8 (6.2 to 7.4) | .12 | .21 |
| Lines of inquiry, history, mean N/case | 14 (12 to 16) | 18 (16 to 20) | 17 (15 to 20) | .41 | .77 |
| Diagnostic hypotheses | |||||
| Diagnostic hypotheses evaluated; mean N/case | 14 (12 to 15) | 16 (15 to 18) | 16 (14 to 17) | .41 | .04 |
| Relevance of diagnostic hypotheses†, mean/case | 0.69 (0.66 to 0.72) | 0.49 (0.46 to 0.52) | 0.49 (0.46 to 0.52) | <.001 | .83 |
| Findings collected until final diagnosis first generated, mean N/case | 9.8 (7 to 12) | 24 (16 to 32) | 23 (15 to 32) | .008 | .03 |
| Final decisions | |||||
| Unique decisions made, mean N/case | 7 (6 to 8) | 8 (7 to 9) | 8 (7 to 9) | .36 | .005 |
| Relevance of distinct decisions†, mean/case | 0.69 (0.64 to 0.73) | 0.42 (0.37 to 0.47) | 0.52 (0.47 to 0.56) | <.001 | .21 |
*
ANOVA with subjects nested within experience levels and repeated measures for cases. Numbers in brackets denote 95% confidence intervals.
†
Relevance of information collected, diagnostic hypotheses generated, or decisions made, is their level of concordance (from 0, 0% concordance to 1, 100% concordance) among experts reaching the correct diagnoses. Key questions, decisions, or diagnostic hypotheses are those elicited by all members of this reference group.
‡
Examples of body systems: respiratory, neurological. One line of inquiry is a sequence of consecutive questions evaluating the same diagnostic hypothesis.