Comparison of the Outpatient Diagnostic Process Between Novice and Trained Residents

Abstract

Objective : The outpatient diagnostic processes of novice and trained residents were compared, as to the working diagnosis time and the correct tentative diagnosis rate after history taking to the final diagnosis.
Methods : Three physicians who had received outpatient training in our department for ≥2 years were defined as “trained residents”, and another three physicians participated in this study from their first day of training at the outpatient clinic were defined as “novice residents”. The study was done at Chiba University Hospital in Japan. The working diagnosis time was defined as the time for the physicians to make a tentative diagnosis for each patient based on history taking, and was calculated from the starting and ending times entered into a computer. By comparing the working diagnoses and the final diagnoses, the correct diagnosis rate was determined for each physician.
Results : The correct diagnosis rates for trained residents were 87%, 87%, and 85%, respectively. These rates were significantly higher than those of novice residents, which were 73%, 69%, and 55%, respectively (all P<0.001). The working diagnosis times of trained residents were significantly shorter than those of novice residents (all P<0.001). The trained residents still made mostly correct diagnoses after a long time, while the novice residents made more wrong diagnoses as time passed.
Conclusion : The working diagnosis time was shorter and the correct diagnosis rate was higher in the trained resident group than the novice resident group. Trained residents were able to eventually make a correct diagnosis, even when they failed to make the correct diagnosis initially. On the other hand, the correct tentative diagnosis rate was generally lower for novice residents, and the rate was markedly lower when patients had diseases that could not be diagnosed at an early stage.