Title: Comparison of physicians' evidence based decisions with
the Bayesian use of the evidence.
American Psychological Annual Meetings, San Francisco, August 26, 2001.
Alan Schwartz, PhD.
Assistant Professor
Departments of Medical Education and Pediatrics
University of Illinois-Chicago
Chicago, IL 60612-7309
The recent movement toward 'evidence-based medicine' has emphasized the importance of physicians using the best available data to inform their clinical decisions, particularly primary literature and reviews of high methodological quality. Evidence-based practice demands skill in information retrieval, assessment of study validity, and application of assessed evidence to a clinical decision. However, few efforts have been made to study how well physicians revise their beliefs about a clinical decision in the presence of new evidence.
We presented Pediatrics residents at two sites
with a series of patient case vignettes in which they had to make a clinical decision
and state their confidence or level of belief in the decision. Each vignette
was then followed with evidence in the form of a structured abstract adapted
from the clinical literature, and the respondent again made the decision and
stated their confidence. Across vignettes, problem type (diagnosis, therapy, or
prognosis), evidence methodological validity (strong or weak), and evidence
results (favoring a new intervention or the accepted standard) were varied. In
this presentation, the performance of
groups of residents with varying exposure to training in evidence-based
medicine will be described and compared with Bayes' theorem, a normative model
for belief revision in the face of new evidence. Implications for clinical
decision making and medical education will be discussed.
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