Medical students' and residents' estimates of cardiac risk

Resident physicians' and medical students' perceptions of atherosclerotic heart disease (ASHD) risks and their understanding of risk appraisal concepts were studied. Subjects estimated the average risks of death from ASHD, from motor vehicle accidents, and from all causes for men in three age groups. Given a patient with severe hypertension, they then estimated relative risk and used their estimates to calculate individual patient risks. Risk estimates varied widely. Only 36% of the subjects were consistently accurate estimators of ASHD and all-causes risks. Subjects who had family histories of heart disease performed significantly better than others. Only about half the subjects were able to compute the hypertensive patient's risk correctly. Thus, residents and students were not adept at estimating the average risks of death from various causes or using the estimates to assess a patient's risk. Better physician understanding of these concepts might lead to improved patient counseling in risk factor reduction.