Enhancement of clinicians' Diagnostic reasoning by computer-based consultation : A multisite study of 2 systems

Results Correct diagnoses appeared in subjects’ hypothesis lists for 39.5% of cases prior to consultation and 45.4% of cases after consultation. Subjects’ mean diagnostic quality scores increased from 5.7 (95% confidence interval [CI], 5.5-5.9) to 6.1 (95% CI, 5.9-6.3) (effect size: Cohen d = 0.32; 95% CI, 0.23-0.41; P,.001). Larger increases (P = .048) were observed for students than for residents and faculty. Effect size varied significantly (P,.02) by DSS (Cohen d = 0.20; 95% CI, 0.08-0.32 for ILIAD vs Cohen d = 0.45; 95% CI, 0.31-0.59 for QMR). Conclusions Our study supports the idea that “hands-on” use of diagnostic DSSs can influence diagnostic reasoning of clinicians. The larger effect for students suggests a possible educational role for these systems.