Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Aug;8(4):230-236.
doi: 10.1007/s40037-019-0522-5.

Effects of deliberate reflection on diagnostic accuracy, confidence and diagnostic calibration in dermatology

Galileu B Costa Filho  1 , Alexandre S Moura  2 , Paulo R Brandão  2 , Henk G Schmidt  3 , Silvia Mamede  3
Affiliations

Effects of deliberate reflection on diagnostic accuracy, confidence and diagnostic calibration in dermatology

Galileu B Costa Filho et al. Perspect Med Educ. 2019 Aug.

Abstract

Background: Deliberate reflection on initial diagnoses improved diagnostic accuracy in internal medicine and general practice, but it is unknown if the same occurs in specialties that rely mostly on visual perception, such as dermatology. Moreover, whether reflection influences diagnostic calibration has not been studied yet. Diagnostic calibration, the relationship between diagnostic accuracy and confidence in that accuracy, affects diagnostic performance because overconfidence tends to induce premature closure. This study evaluated the effects of deliberate reflection on diagnostic accuracy and diagnostic calibration in dermatology.

Methods: Sixty-one sixth-year students from a Brazilian medical school were allocated to either a reflection group (RG) or a control group (CG). In both groups, students worked with the same 12 dermatological images, presented sequentially, providing an initial diagnosis and confidence in that diagnosis. Subsequently, RG students reflected on the case using a structured procedure, while CG students performed a time-filler activity. All students then provided a final diagnosis and confidence in that diagnosis. Outcome measurements were diagnostic accuracy, confidence, and calibration.

Results: Reflection increased diagnostic accuracy relative to control (49.7 ± 12.1 vs 38.4 ± 14.6; p = 0.002) but did not affect confidence (64.3 ± 13.2 vs 58.9 ± 20.1; p = 0.228) nor calibration (0.15 ± 0.16 vs 0.20 ± 0.19, p = 0.197). Overall, case difficulty influenced calibration, with students showing more overconfidence on more difficult cases (p <0.001).

Conclusions: Deliberate reflection increased diagnostic accuracy in dermatology but did not affect confidence and calibration. Calibration was worse on more difficult cases, suggesting that calibration is a knowledge-related phenomenon.

Keywords: Clinical reasoning; Deliberate reflection; Diagnostic calibration; Medical education.

PubMed Disclaimer

References

    1. Kohn LT, Corrigan J, Donaldson MS. To err is human: building a safer health system. Washington: National Academy Press; 1999. - PubMed
    1. Makary MA, Michael D. Medical error—the third leading cause of death in the US. BMJ. 2016;353:i2139. doi: 10.1136/bmj.i2139. - DOI - PubMed
    1. Singh H, Graber ML, Kissam SM, Tant ET, Henriksen K, LaBresh KA. System-related interventions to reduce diagnostic errors: a narrative review. BMJ Qual Saf. 2012;21:160–170. doi: 10.1136/bmjqs-2011-000150. - DOI - PMC - PubMed
    1. Croskerry P, Norman G. Overconfidence in clinical decision making. Am J Med. 2008;121(5 Suppl):S24–S29. doi: 10.1016/j.amjmed.2008.02.001. - DOI - PubMed
    1. Graber ML. The incidence of diagnostic error in medicine. BMJ Qual Saf. 2013;22(Suppl 2):ii21–ii27. doi: 10.1136/bmjqs-2012-001615. - DOI - PMC - PubMed