05 août 2022

Interrompre un raisonnement diagnostique n’en altère pas l’exactitude

Background. Diagnostic error is a major source of patient suffering. Research shows that physicians experience frequent interruptions while being engaged with patients and indicate that diagnostic accuracy may be impaired as a result. Since most studies in the field are observational, there is as yet no evidence suggesting a direct causal link between being interrupted and diagnostic error. The experiments reported in this article were intended to assess this hypothesis. Methods. Three experiments were conducted to test the hypothesis that interruptions hurt diagnostic reasoning and increase time on task. In the first experiment (N=42), internal medicine residents, while diagnosing vignettes of actual clinical cases were interrupted halfway with a task unrelated to medicine, solving word-spotting puzzles and anagrams. In the second experiment (N=78), the interruptions were medically relevant ones. In the third experiment (N=30), we put additional time pressure on the participants. In all these experiments, a control group diagnosed the cases without interruption. Dependent variables were diagnostic accuracy and amount of time spent on the vignettes. Results. In none of the experiments interruptions were demonstrated to influence diagnostic accuracy. In Experiment 1: Mean of interrupted group was 0.88 (SD=0.37) versus non- interrupted group 0.91 (SD=0.32). In Experiment 2: Mean of interrupted group was 0.95 (SD=0.32) versus non-interrupted group 0.94 (SD=0.38). In Experiment 3: Mean of interrupted group was 0.42 (SD=0.12) versus non-interrupted group 0.37 (SD=0.08). Although interrupted residents in all experiments needed more time to complete the diagnostic task, only in Experiment 2, this effect was statistically significant. Conclusions. These three experiments, taken together, failed to demonstrate negative effects of interruptions on diagnostic reasoning. Perhaps physicians who are interrupted may still have sufficient cognitive resources available to recover from it most of the time.

Commentaire du Dr Marius Laurent (PAQS)

  • Ceci n’est pas la première démonstration expérimentale du peu d’effets qu’ont les interruptions du processus diagnostique sur l’exactitude des résultats (Monteiro SD, Sherbino JD, Ilgen JS, et al. Disrupting diagnostic reasoning: do interruptions, instructions, and experience affect the diagnostic accuracy and response time of residents and emergency physicians ? Acad Med 2015;90(4):511-7.) Assez curieusement, l’effet des interruptions, dont les dangers sont bien documentés dans des domaines comme l’aéronautique, peine à trouver sa démonstration dans le monde médical, si on excepte le cas particulier de la préparation complexe de médications (dilutions en unités pédiatriques par exemple). En principe, on attendrait d’un processus intellectuel « analytique », non automatique, qu’il soit sensible aux interruptions : ce ne semble pas être le cas. Les interruptions choisies, différentes dans les trois phases de cette expérimentation, sont-elles assez profondes pour « saturer » les capacités intellectuelles des sujets ? Peut-être pas : il s’agit de situations « simulées » de vignettes diagnostiques et d’interruptions dont le contenu psychologique peut différer des interruptions survenant dans la vraie vie.

Alajaji M, Saleh N, AlKhulaif AH, et al. Failure to demonstrate effects of interruptions on diagnostic reasoning: three experiments. BMC Med Educ 2022;22(1):182. Doi : 10.1186/s12909-022-03212-1.