Interventions to improve diagnostic decision making: A systematic review and meta-analysis on reflective strategies

<b>Aims:</b> To identify, appraise and describe studies of cognitive interventions to improve diagnostic decision making (DDM) amongst medical professionals, assess their effectiveness and identify methodological limitations in existing studies. <b>Methods:</b> We systematically searched for studies (publication date 2000–2016) in multiple databases including Cochrane Controlled Trials, EMBASE, ERIC, Medline, PubMed and PsycINFO, and used additional strategies such as hand searching and snowballing. Included studies evaluated cognitive interventions to enhance DDM amongst medical professionals, using defined outcomes such as diagnostic accuracy. A meta-analysis assessed the impact of <i>“</i>reflection<i>”</i>. <b>Results:</b> Forty-four studies out of 10,114 screened citations, involving 4380 medical professionals, were included. Studies evaluated reasoning workshops/curricula, de-biasing workshops, checklists, reflection, feedback, and instructions to induce analytical thinking. Guided reflection was demonstrated to improve DDM [effect size 0.38(95%CI 0.23–0.52), <i>p</i><b><i> </i></b> <b>Conclusions:</b> Educational interventions incorporating practising deliberate reflection on a formulated diagnosis, modeled reflection on contrasting examples and immediate feedback are promising strategies for improving DDM. The effectiveness of other strategies is unknown, with more methodological refinements required in future research.

<b>研究目的：</b> 识别、评价并描述针对医疗专业人员提升诊断决策（Diagnostic Decision Making, DDM）的认知干预相关研究，评估其有效性，并明确现有研究存在的方法学局限。<b>研究方法：</b> 本研究系统检索了2000年至2016年发表于Cochrane对照试验数据库、EMBASE、ERIC、Medline、PubMed及PsycINFO等多个数据库的相关研究，并辅以手工检索、滚雪球检索等补充检索策略。纳入研究需针对医疗专业人员提升诊断决策的认知干预进行效果评价，采用诊断准确率等明确的结局指标。本研究通过元分析（meta-analysis）评估<i>“</i>反思<i>”</i>的干预效应。<b>研究结果：</b> 在初筛的10114篇引文中，最终纳入44项研究，共计涉及4380名医疗专业人员。纳入研究评估的干预手段涵盖推理工作坊/课程、去偏误工作坊、核查清单、反思、反馈及诱导分析性思维的指导方案等。研究证实，引导式反思可有效提升诊断决策能力[效应量0.38(95%置信区间0.23–0.52), p]。<b>研究结论：</b> 整合了针对明确诊断开展刻意练习反思、基于对比范例的建模反思以及即时反馈的教育干预策略，在提升诊断决策方面展现出良好的应用前景。其余干预策略的有效性尚未明确，未来研究需进一步优化方法学设计。