Clinical trial NCT05760859: Quality of Medical History Taking and Diagnostic Accuracy
Official title: Effects of Initial Cues and the Quality of Medical History Taking on Diagnostic Accuracy
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Diagnostic Error
Keywords: medical simulation
diagnostic error
pulmonary embolism
Lead sponsor: University Hospital, Basel, Switzerland
Sponsor class: OTHER
First posted: 2023-03-08
Enrollment: 198
Sex: ALL
Minimum age (years): 20
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: yes
Allocation: RANDOMIZED
Intervention model: PARALLEL
Intervention model description: Participants were randomized (computer-generated numbers) to six versions of a simulated scenario of pulmonary embolism. The six versions differed only in the initial cues, i.e. in the reply of the patient to the initial question about the reason for his visit.
Primary purpose: DIAGNOSTIC

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

Detailed 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.

Eligibility criteria: Inclusion Criteria:

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

Exclusion Criteria:

* decline to give written informed consent

Primary outcomes:
measure: Stating the correct diagnosis
timeFrame: 5 minutes
Secondary outcomes:
measure: Depth of history taking
timeFrame: 5 minutes
measure: Breadth of history taking
timeFrame: 5 minutes
measure: Systematics of history taking
timeFrame: 5 minutes
Other outcomes:
Locations:
city: Basel
country: Switzerland
facility: University Hospital
state: BS
Study officials:
affiliation: University Hospital of Basel
name: Stephan Marsch, MD
role: PRINCIPAL_INVESTIGATOR
References: