Impact of performance and information feedback on medical interns' confidence-accuracy calibration.

Diagnostic errors are a major, largely preventable, patient safety concern. Error interventions cannot feasibly be implemented for every patient that is seen. To identify cases at high risk of error, clinicians should have a good calibration between their perceived and actual accuracy. This experiment studied the impact of feedback on medical interns' calibration and diagnostic process. In a two-phase experiment, 125 medical interns from Dutch University Medical Centers were randomized to receive no feedback (control), feedback on their accuracy (performance feedback), or feedback with additional information on why a certain diagnosis was correct (information feedback) on 20 chest X-rays they diagnosed in a feedback phase. A test phase immediately followed this phase and had all interns diagnose an additional 10 X-rays without feedback. Outcome measures were confidence-accuracy calibration, diagnostic accuracy, confidence, and time to diagnose. Both feedback types improved overall confidence-accuracy calibration (R2No Feedback = 0.05, R2Performance Feedback = 0.12, R2Information Feedback = 0.19), in line with the individual improvements in diagnostic accuracy and confidence. We also report secondary analyses to examine how case difficulty affected calibration. Time to diagnose did not differ between conditions. Feedback improved interns' calibration. However, it is unclear whether this improvement reflects better confidence estimates or an improvement in accuracy. Future research should examine more experienced participants and non-visual specialties. Our results suggest that feedback is an effective intervention that could be beneficial as a tool to improve calibration, especially in cases that are not too difficult for learners.

Staal J ，Katarya K ，Speelman M ，Brand R ，Alsma J ，Sloane J ，Van den Broek WW ，Zwaan L ... -  《-》

Surgical Practical Skills Learning Curriculum: Implementation and Interns' Confidence Perceptions.

Acosta D ，Castillo-Angeles M ，Garces-Descovich A ，Watkins AA ，Gupta A ，Critchlow JF ，Kent TS ... -  《-》

Interns' perceptions of performance feedback.

Internship, the first year after medical school, is an important time for identity formation and role development. Effective performance feedback is essential for identifying strengths and weaknesses, guiding self-regulation to improve clinical performance and developing accurate self-assessment. However, developing feedback systems is notoriously difficult. A better understanding of interns' perspectives is important to increase engagement with feedback systems and to improve their effectiveness. This study explores the interns' role clarity and confidence in evaluating their own performance; their views of the existing health care organisation's formal performance appraisal system based on national intern assessment tools and guidelines and whether the self-directed audit of clinical tasks is a feasible feedback tool. Qualitative data were collected through a cross-sectional survey using semi-structured interviews with interns in their last week of employment from a single large regional public health care organisation in Australia. Interviewee-verified data were analysed thematically using a 'framework' approach. Twenty-one of 28 interns were included in the final analyses. We found that interns conceptualise good performance in terms of efficient completion of daily tasks and are unable to confidently judge their own performance. The current health care organisation performance appraisal system based on national intern assessment tools and guidelines does not meet their expectations and could be improved through greater involvement of the medical staff who work alongside interns on a daily basis, particularly registrars and regular, scheduled opportunities for formative and informal feedback with a focus on personalised, constructive feedback. The introduction of specific task assessments or audit, such as a formal appraisal of patient discharge documentation, is also valued. Performance appraisal formats need improving to better align with interns' expectations, to meet interns' learning goals and to improve practices in the health care organisation.

Ibrahim J ，MacPhail A ，Chadwick L ，Jeffcott S ... -  《-》

Does a suggested diagnosis in a general practitioners' referral question impact diagnostic reasoning: an experimental study.

Diagnostic errors are a major cause of preventable patient harm. Studies suggest that presenting inaccurate diagnostic suggestions can cause errors in physicians' diagnostic reasoning processes. It is common practice for general practitioners (GPs) to suggest a diagnosis when referring a patient to secondary care. However, it remains unclear via which underlying processes this practice can impact diagnostic performance. This study therefore examined the effect of a diagnostic suggestion in a GP's referral letter to the emergency department on the diagnostic performance of medical interns. Medical interns diagnosed six clinical cases formatted as GP referral letters in a randomized within-subjects experiment. They diagnosed two referral letters stating a main complaint without a diagnostic suggestion (control), two stating a correct suggestion, and two stating an incorrect suggestion. The referral question and case order were randomized. We analysed the effect of the referral question on interns' diagnostic accuracy, number of differential diagnoses, confidence, and time taken to diagnose. Forty-four medical interns participated. Interns considered more diagnoses in their differential without a suggested diagnosis (M = 1.85, SD = 1.09) than with a suggested diagnosis, independent of whether this suggestion was correct (M = 1.52, SD = 0.96, d = 0.32) or incorrect ((M = 1.42, SD = 0.97, d = 0.41), χ2(2) =7.6, p = 0.022). The diagnostic suggestion did not influence diagnostic accuracy (χ2(2) = 1.446, p = 0.486), confidence, (χ2(2) = 0.058, p = 0.971) or time to diagnose (χ2(2) = 3.128, p = 0.209). A diagnostic suggestion in a GPs referral letter did not influence subsequent diagnostic accuracy, confidence, or time to diagnose for medical interns. However, a correct or incorrect suggestion reduced the number of diagnoses considered. It is important for healthcare providers and teachers to be aware of this phenomenon, as fostering a broad differential could support learning. Future research is necessary to examine whether these findings generalize to other healthcare workers, such as more experienced specialists or triage nurses, whose decisions might affect the diagnostic process later on. The study protocol was preregistered and is available online at Open Science Framework ( https://osf.io/7de5g ).

Staal J ，Speelman M ，Brand R ，Alsma J ，Zwaan L ... -  《BMC Medical Education》

Learning, education and satisfaction after compulsory rotating internship in Kathmandu University Medical School: a qualitative study of interns' response.

Shrestha D ，Mishra B 《-》