Did medical doctors who order abdominal CT scans during on-call hours truly become worse at clinical reasoning? Yes, they did

Selin Ersoydan, Derya Yakar, Ömer Kasalak, Thomas C. Kwee*

*Bijbehorende auteur voor dit werk

OnderzoeksoutputAcademicpeer review

1 Citaat (Scopus)
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Samenvatting

Objective
To investigate temporal changes in clinical reasoning quality of physicians who requested abdominal CT scans at a tertiary care center during on-call hours within a 15-year period.

Methods
This retrospective study included 531 patients who underwent abdominal CT at a tertiary care center during on-call hours on 36 randomly sampled unique calendar days in each of the years between 2005 and 2019. Clinical reasoning quality was expressed as a percentage (0–100%), taking into account the degree by which the differential diagnoses on the CT request form matched the CT diagnosis. Temporal changes in the quality of clinical reasoning and number of CT scans were assessed using Mann-Kendall tests. Associations between the quality of clinical reasoning with patient age and gender, requesting department, and time of CT scanning were determined with linear regression analyses.

Results
The median annual clinical reasoning score was 0.4% (interquartile range: 0.3 to 0.6%; range: 0.1 to 1.9%). The quality of clinical reasoning significantly decreased between 2005 and 2019 (Mann-Kendall Tau of −0.829, p < 0.001), while the number of abdominal CT scans significantly increased (Mann-Kendall tau of 0.790, p < 0.001). There was a significant association between the quality of clinical reasoning and patient age (β coefficient of 0.210, p = 0.002). The quality of clinical reasoning was not significantly associated with patient gender, requesting department, or time of CT scanning.

Conclusion
The clinical reasoning quality of physicians who request abdominal CT scans during on-call hours has deteriorated over time. Clinical reasoning appears to be worse in younger patients.
Originele taal-2English
TijdschriftEuropean Radiology
DOI's
StatusE-pub ahead of print - 7-sep.-2022

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