Ordering patterns for laboratory and radiology tests by students from different undergraduate medical curricula

Abstract

BackgroundThe overuse of laboratory tests and radiology imaging and their possible hazards to patients and the health care system is observed with growing concern in the medical community. With this study the authors wished to determine whether ordering patterns for laboratory and radiology tests by medical students close to their graduation are related to undergraduate training.MethodsWe developed an assessment for near graduates in the setting of a resident’s daily routine including a consultation hour with five simulated patients, three hours for patient work up with simulated distracting tasks, and thirty minutes for reporting of patient management to a supervisor. In 2011, 60 students participated in this assessment: 30 from a vertically integrated (VI) curriculum (Utrecht, The Netherlands) and 30 from a traditional, non-VI curriculum (Hamburg, Germany). We assessed and compared the number of laboratory and radiology requests and correlated the results with the scores participants received from their supervisors for the facet of competence “scientifically and empirically grounded method of working”.ResultsStudents from a VI curriculum used significantly (p < .01) less total laboratory requests (N = 283 versus N = 466) which correlated with their scores for a “scientifically and empirically grounded method of working” (Pearson’s r = .572). A significantly (p < .01) higher number of radiology imaging was ordered with a large effect size (V = .618) by near graduates from a non-VI curriculum (N = 156 versus N = 97) even when this was not supporting the diagnostic process.ConclusionThe focused ordering patterns from VI students might be a result of their early exposure to the clinical environment and a different approach to clinical decision making during their undergraduate education which further studies should address in greater detail.

Assessing Competences in Medical Students with a Newly Designed 360- Degree Examination of a Simulated First Day of Residency: A Feasibility Study

“…Even though undergraduate medical students are nowadays introduced earlier to clinical taskseven at medical schools with traditional curricula comprising preclinical and clinical courses -being assessed with multiple choice exams during undergraduate training might foster the believe of certainty in medical decisions in students [29]. Facing patient management, even when the patients are only simulated, leads to a large number of unnecessary laboratory and radiology tests ordered by German medical students [15] in the attempt to prevent mistakes and to reduce the uncomfortable feeling of uncertainty. Inducing the feeling of uncertainty in less advanced students during the patient management phase of our assessment might be another indicator how realistic the perception of the assessment was.…”

“…Students from a vertically integrated curriculum in the Netherlands reached significantly higher scores than students from Hamburg for the competence "active professional development" comprising 'reflection' and 'asking for feedback' and for the entrustable professional activity "solving a management problem" [14]. Furthermore, the Dutch students ordered significantly less laboratory and radiology tests compared to the German students with no difference in the diagnostic accuracy for the five simulated patients [15]. We repeated the previous ranking study performed among physician educators in the Netherlands and Germany with 25 essential competences that enable trust in graduates [13,16].…”

Strategies to Reduce Inappropriate Laboratory Blood Test Orders in Intensive Care Are Effective and Safe: A Before-And-After Quality Improvement Study

“…Whilst we did not study this variable, it emphasises the importance of a uniform buy-in by all intensivists, as was the case in our study. Ordering patterns are also shown to correlate with duration of clinical exposure, with those taught to rely on clinical examination and judgement early in training likely to order less laboratory tests 22 . Thus, by setting an example by direct demonstration of appropriate test ordering, the trainees may learn the right habits thus ensuring future compliance.…”

Implementation of a Clinical Reasoning Course in the Internal Medicine trimester of the final year of undergraduate medical training and its effect on students' case presentation and differential diagnostic skills

“…Apparently, the skill to assess test results with respect to their relevance for a specific case is practiced not enough in undergraduate medical education in Germany. This is demonstrated in another study, where German medical students order significantly more laboratory and radiology tests in a study with simulated patients compared with Dutch medicals students, while there is no difference in making the correct diagnosis between the two groups [ 17 ]. The learning progress experienced by the students with respect to ordering medical tests seems to be a reference that the awareness for the relevance of overdiagnosis can be raised by a case based clinical reasoning course in a way similar to the results presented for a problem based course for incorrect prescriptions of medication [ 18 ].…”