Quality of Medical History Taking and Diagnostic Accuracy

NCT ID: NCT05760859

Last Updated: 2023-03-08

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: NA
• Total Enrollment: 198 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2014-03-31
• Study Completion Date: 2019-12-31

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.

Conditions

Diagnostic Error

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: DIAGNOSTIC
• Blinding Strategy: SINGLE

Study Groups

Chest pain

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

Group Type: EXPERIMENTAL

Initial cue

Intervention Type: OTHER

Symptom volunteered by the "patient"

Dyspnoea

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

Group Type: EXPERIMENTAL

Initial cue

Intervention Type: OTHER

Symptom volunteered by the "patient"

Chest pain AND Dyspnoea

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

Group Type: EXPERIMENTAL

Initial cue

Intervention Type: OTHER

Symptom volunteered by the "patient"

Chest pain AND dyspnoea, AND leg pain

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

Group Type: EXPERIMENTAL

Initial cue

Intervention Type: OTHER

Symptom volunteered by the "patient"

Chest pain AND dyspnoea, AND immobilization

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

Group Type: EXPERIMENTAL

Initial cue

Intervention Type: OTHER

Symptom volunteered by the "patient"

Chest pain AND dyspnoea, AND leg pain AND immobilization

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"

Group Type: EXPERIMENTAL

Initial cue

Intervention Type: OTHER

Symptom volunteered by the "patient"

Interventions

Initial cue

Symptom volunteered by the "patient"

Intervention Type: OTHER

Eligibility Criteria

Inclusion Criteria

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

Exclusion Criteria

• decline to give written informed consent

• Minimum Eligible Age: 20 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: Yes

Sponsors

University Hospital, Basel, Switzerland

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Stephan Marsch, MD

Role: PRINCIPAL_INVESTIGATOR

University Hospital of Basel

Locations

University Hospital

Basel, Canton of Basel-City, Switzerland

Countries

Switzerland

Other Identifiers

4031_Sim_MedHistory

Identifier Type: -

Identifier Source: org_study_id