Effects of the use of differential diagnosis checklist and general de-biasing checklist on diagnostic performance in comparison to intuitive diagnosis

Figures & data

Table

Practice points

The use of DDXCs may improve diagnostic performance in difficult cases, but it might lead to lower performance in simple cases. GDBC did not help medical students for better diagnostic performance. Our results may support the dual processing theory implying that analytical process works better for difficult cases and intuitive process may be more effective for solving easy cases.

Table 1  Score distribution of intuitive diagnosis, diagnosis by GDBC, and diagnosis by DDXC (n = 188)

	Case 1	Case 2	Case 3	Case 4	Case 5
Group 1 (n = 91)
Intuitive diagnosis (n)
Score
0	5	6	39	55	76
1	0	2	2	8	0
2	14	11	6	12	4
3	72	72	44	16	11
Diagnosis by GDBC (n)
Score
0	5	6	39	51	74
1	0	4	2	10	2
2	13	6	5	12	2
3	73	75	45	18	13
Diagnosis by DDXC (n)
Score
0	7	8	33	35	68
1	1	3	3	15	6
2	11	10	10	20	7
3	72	70	45	21	10
Group 2 (n = 97)
Intuitive diagnosis (n)
Score
0	11	11	49	70	90
1	3	5	3	3	2
2	3	8	9	8	3
3	80	73	36	16	2
Diagnosis by DDXC (n)
Score
0	12	20	39	58	71
1	3	2	5	9	6
2	6	7	5	11	4
3	76	68	48	19	16
Diagnosis by GDBC (n)
Score
0	12	17	38	56	71
1	2	5	7	9	4
2	7	4	4	11	5
3	76	71	48	21	17

Note: GDBC, general de-biasing checklist and DDXC, differential diagnosis checklist.

Table 2  Mean scores of intuitive diagnosis, diagnosis by GDBC, and diagnosis by DDXC (n = 188)

Group 1 (n = 91)
Cases	Intuitive diagnosis	Diagnosis by GDBC
Easy (cases 1 and 2)	2.66	2.67
Hard (cases 3–5)	0.98	1.03
Cases	Intuitive diagnosis	Diagnosis by DDXC
Easy (cases 1 and 2)	2.66	2.60
Hard (cases 3–5)	0.98	1.20
Group 2 (n = 97)
Cases	Intuitive diagnosis	Diagnosis by DDXC
Easy (cases 1 and 2)	2.52	2.39
Hard (cases 3–5)	0.72	1.06
Cases	Intuitive diagnosis	Diagnosis by GDBC
Easy (cases 1 and 2)	2.52	2.43
Hard (cases 3–5)	0.72	1.09

Note: GDBC, general de-biasing checklist and DDXC, differential diagnosis checklist.

Figure 1. Proportions of correct diagnosis of intuitive diagnosis, diagnosis by GDBC, and diagnosis by DDXC by the groups 1 and 2. Notes: The horizontal axis indicates the proportions of correct diagnosis. GDBC, general de-biasing checklist and DDXC, differential diagnosis checklist.

Figure A.1. Cranial plain computed tomography (case 2).

Figure A.2. Chest X-ray (case 3).

Figure A.3. Abdominal echography (case 3).

Figure A.4. Chest X-ray (case 5).

Figure A.5. Abdominal plain computed tomography (case 5).

Figure A.6. Abdominal contrast-enhanced computed tomography (case 5, mid-abdomen level).

Figure A.7. Abdominal contrast-enhanced computed tomography (case 5, low-abdomen level).

Table

Proposed general checklist for diagnosis
• Obtain your own complete medical history
• Perform a focused and purposeful physical exam
• Generate initial hypotheses and differentiate these with additional history, physical exam, and diagnostic tests
• Pause to reflect-take diagnostic “time out”
– Was I comprehensive?
– Did I consider the inherent flaws of heuristic thinking?
– Was my judgment affected by any other bias?
– Do I Need to make the diagnosis now, or can I wait?
– What is the worst-case scenario?
• Embark on a plan, but acknowledge uncertainty and ensure a pathway for follow-up