Submission ID 78174

Code OF-4-2
At the end of this workshop, participants will be able to:
Category Medical Education
Type Oral
Will the presenter be a: Other
Presenter Other Education Research Scientist
Title Are Two (or More) Heads Better than One?
Background/Purpose Involvement of multiple clinicians in diagnosis has been proposed to reduce diagnostic error using two broad strategies- interactive groups, where active discussion occurs, and nominal groups, where individual judgments are retrospectively combined statistically. While in practice interactive discussion is likely the primary mode, research is dominated by studies of nominal groups. How (or if) expert clinicians benefit from group interactions, and the relation to group size, has not been studied.
Methods 12 general medicine written case vignettes were used. Participants (N=36) individually reviewed 4 case vignettes and provided a diagnosis and differential with up to 5 diagnoses. Residents were then formed into virtual groups of 3 (4 groups) and given 4 new cases, and asked to form a group consensus. Subsequently, in groups of 6, the consensus process repeated. In a post-hoc analysis, nominal groups were created by combining individual responses in the first phase into groups of 3 and 6. Accuracy scores (0, 1, 2) were assigned to all responses.
Results The nominal groups considered substantially more unique diagnoses: 7.23 vs 3.12 (n=3 per group) and 12.5 vs 3.0 (n=6 per group), p<.001). Group size and Nominal/Interactive did not influence diagnostic accuracy. Group size did not influence quality of differential. Accuracy for nominal groups was higher compared to interactive.
Discussion While multiple clinicians yield more accurate diagnoses than any individual, there is no advantage of groups of 6 over groups of 3. Conversely pooling results post hoc from independent clinicians has considerable advantage over actual group discussion.
Keyword 1 Diagnostic reasoning
Keyword 2 Group consult
Keyword 3
Abstract content most relevant to: (check all that apply) Continuing Professional Development (CPD) (faculty development, CME)
Abstract Track - First Choice Faculty Development
Authors Geoffrey Norman
Matthew Sibbald
Sandra Monteiro
Jonathan Sherbino

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