Quality of Medical History Taking and Diagnostic Accuracy

University Hospital Basel

Status: Completed

Conditions: Diagnostic Error

Treatments: Other: Initial cue

Study type: Interventional

Funder types: Other

Identifiers

NCT05760859

4031_Sim_MedHistory

Details and patient eligibility

About

This prospective randomized simulator-based single-blind trial aimed to investigate the effects of initial cues and history taking skills on diagnostic accuracy

Full description

Diagnostic errors are a relevant health-care problem. As medical history taking is usually the first step in a patient's assessment its quality is most likely a first and important barrier against diagnostic errors. There are, however, only limited data on the association of the quality of medical history taking and diagnostic accuracy.This prospective randomized simulator-based single-blind trial aimed to investigate the effects of initial cues and history taking skills on diagnostic accuracy. 198 medical students (135 females) were given the task to assess a patient presenting with simulated acute pulmonary embolism. Participants were randomized to six versions of the scenario differing only in the initial cues, i.e. in the reply of the patient to the initial question about the reason for his visit. In three of six versions, initial cues were restricted to thoracic symptoms (chest pain, dyspnoea, or combination of both). In the remaining three versions, initial cues consisted of thoracic and extra-thoracic (leg pain, immobilization) symptoms. The primary outcome was diagnostic accuracy. The mannequin was equipped with a speaker in its head that broadcasts the voice of a remote operator (experienced physician) allowing verbal interaction of the participants with the "patient". The "patient" did not speak unless asked and responded to all participants' questions during history taking according to a pre-defined checklist.

Enrollment: 198 patients

Sex: All

Ages: 20+ years old

Volunteers: Accepts Healthy Volunteers

Inclusion criteria

• 4th year medical students participating in voluntary simulator-based workshops

Exclusion criteria

• decline to give written informed consent

Trial design

Primary purpose: Diagnostic

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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198 participants in 6 patient groups

Chest pain

Experimental group

Description:

Patient answers the initial question of history taking on why he had come to the hospital with "Chest pain"

Treatment:

Other: Initial cue

Dyspnoea

Experimental group

Description:

Patient answers the initial question of history taking on why he had come to the hospital with "Dyspnoea"

Treatment:

Other: Initial cue

Chest pain AND Dyspnoea

Experimental group

Description:

Patient answers the initial question of history taking on why he had come to the hospital with "Chest pain, and Dyspnoea"

Treatment:

Other: Initial cue

Chest pain AND dyspnoea, AND leg pain

Experimental group

Description:

Patient answers the initial question of history taking on why he had come to the hospital with "Chest pain, and Dyspnoea, and leg pain"

Treatment:

Other: Initial cue

Chest pain AND dyspnoea, AND immobilization

Experimental group

Description:

Patient answers the initial question of history taking on why he had come to the hospital with "Chest pain, and Dyspnoea, and immobilization"

Treatment:

Other: Initial cue

Chest pain AND dyspnoea, AND leg pain AND immobilization

Experimental group

Description:

Patient answers the initial question of history taking on why he had come to the hospital with "Chest pain, and Dyspnoea, and leg pain, and immobilization"

Treatment:

Other: Initial cue