原创力文档Effect of Supervised Students' Involvement on Diagnostic Accuracy in Hospitalized Medical Patients — A Prospective Controlled Study 英文参考文献.doc
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Effect of Supervised Students' Involvement on Diagnostic Accuracy in Hospitalized Medical Patients — A Prospective Controlled Study 英文参考文献
EffectofSupervisedStudents’Involvementon
DiagnosticAccuracyinHospitalizedMedicalPatients—
AProspectiveControlledStudy
DorotheaAdelheidHerter1,RobertWagner2,FriederikeHolderried3,YelenaFenik1,ReimerRiessen4,
PeterWeyrich2,NoraCelebi2*
1Medical School, University of Tuebingen, Tuebingen, Germany, 2Department for Endocrinology, Diabetology, Nephrology and Angiology, University Hospital of
Tuebingen,Tuebingen,Germany,3OfficeoftheDean,MedicalSchool,UniversityofTuebingen,Tuebingen,Germany,4MedicalIntensiveCareUnit,Tuebingen,Germany
Abstract
Background: During internships most medical students engage in history taking and physical examination during
evaluationofhospitalizedpatients.However,thestudents’abilityforpatternrecognitionisnotasdevelopedasinmedical
expertsandcompletehistorytakingisoftennotrepeatedbyanexpert,soimportantcluesmaybemissed.Ontheother
hand, students’ history taking is usually more extensive than experts’ history taking and medical students discuss their
findings with a Supervisor. Thus the effect of student involvement on diagnostic accuracy is unclear. We therefore
compared the diagnostic accuracy for patients in the medical emergency department with and without student
involvementintheevaluationprocess.
Methodology/PrincipalFindings:Patientsinthemedicalemergencydepartmentwereassignedtoevaluationbyeithera
supervisedmedicalstudentoranemergencydepartmentphysician.Weonlyincludedpatientswhowereadmittedtoour
hospitalandsubsequentlycaredforbyanothermedicalteamontheward.Wecomparedtheworkingdiagnosisfromthe
emergencydepartmentwiththedischargediagnosis.Atotalof310patientsincludedinthestudywerecaredforby41
medicalstudentsand21emergencydepartmentphysicians.Theworkingdiagnosiswaschangedin22%ofthepatients
evaluatedbyphysiciansevaluationandin10%ofthepatientsevaluatedbysupervisedmedicalstudents(p=.006).There
wasnodifferenceintheexpendituresfordiagnosticprocedures,lengthofstayintheemergencydepartmentorpatient
comorbiditycomplexitylevel.
Conclusion/Significance: Invol
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