描述个人临床认知不确定性及其与临床判断的关联
Philippe Simard-Sauriol1, Andréanne Wassef2, Eric Peters3
1Department of Anesthesiology and Critical Care Medicine, CHU de Québec - Université Laval, Québec City, Québec, Canada.
Journal of evaluation in clinical practice
|May 19, 2025
概括
这项研究探讨了医学学习者的个人临床认知不确定性,发现它影响临床判断. 了解和教导容忍不确定性可以改善临床决策和患者的结果.
科学领域:
- 医学教育 医学教育
- 认知心理学 认知心理学
- 临床决策 临床决策
背景情况:
- 临床不确定性通常与情景或个人特征相关研究,但背景和个体特征之间的相互作用未得到充分探索.
- 临床不确定性的个人和认知方面可能在各种认知水平上起作用,影响判断和训练.
- 了解这些细微差别对于改善医疗培训和实践至关重要.
研究的目的:
- 描述和量化个人临床认知不确定性的不同方面.
- 检查这些不确定性测量和临床判断之间的关联.
- 确定改善医学教育和临床绩效的潜在目标.
主要方法:
- 从蒙特利尔大学医院中心招募了120名学习者和24名监督员.
- 学习者完成了15个小组,对他们的不确定性进行评分,并记录了他们的特征和监督者评价的临床判断.
- 量化了五个不确定性指标,并使用相关性和回归来分析与人口统计学,测试成绩和临床判断的关联.
主要成果:
- 较高的临床不确定性与较低的测试分数,较低的训练水平和女性相关.
- 自我报告的一般不确定性与更高的临床不确定性但更低的校准相关,而更高的测试分数与更好的校准相关.
- 较低的自我报告的一般不确定性,较低的不确定性程度和较高的相对/绝对校准与更好的临床判断有关.
结论:
- 确定了五种不同的个人临床认知不确定性指标,每个指标都显示了与临床判断和知识的差异联系.
- 强调个人临床认知不确定性的理解和教学可能会提高临床医生对模两可的容忍度.
- 提高对不确定性的耐受性有可能提高临床判断力,并最终改善患者的治疗结果.
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