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Related Experiment Videos

Laboratory use: attitudes implicit in a national examination.

B P Schmitt1, A S Elstein

  • 1Department of Medicine, University of Illinois College of Medicine, Chicago 60680.

Medical Decision Making : an International Journal of the Society for Medical Decision Making
|April 1, 1988
PubMed
Summary

Medical laboratory test selection is often reluctant. Analysis of assessment programs reveals implicit encouragement of routine, low-cost, low-risk tests, potentially influencing clinical practice.

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Area of Science:

  • Medical Education
  • Clinical Pathology
  • Health Policy

Background:

  • Clinical practice has been slow to adopt quantitative principles for laboratory test selection and interpretation.
  • This reluctance may stem from faculty attitudes toward laboratory diagnostics.

Purpose of the Study:

  • To evaluate faculty attitudes towards laboratory testing by analyzing scoring standards in medical knowledge assessments.
  • To determine if assessment scoring implicitly encourages specific types of laboratory test ordering.

Main Methods:

  • Reviewed scoring standards for 23 patient management problems (PMPs) from 1980 and 1983 Medical Knowledge Self-Assessment Programs.
  • Categorized diagnostic options by cost, risk, and "routineness."
  • Analyzed scores from indiscriminate selection of items within categories to probe attitudes.

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Main Results:

  • Examiners favored routine, low-cost, low-risk laboratory items.
  • Indiscriminate ordering of such items was rewarded 85% of the time with no penalty in 95% of cases.
  • Indifference to low-cost items accounted for 11.7% of acceptable diagnostic expense.

Conclusions:

  • Assessment scoring implicitly encourages the ordering of routine, low-cost, low-risk laboratory tests.
  • This national-level attitude may promote the overuse of these tests in clinical practice.
  • Re-evaluation of assessment criteria is needed to align with evidence-based laboratory utilization.