Reducing variability in treatment decision-making: effectiveness of educating clinicians about uncertainty

Abstract

The objective of this study was to investigate whether or not education about the concept of uncertainty reduced variability in treatment decision-making. Three small groups of dentists in North York, Canada were asked to make restorative treatment decisions about simulated bitewing radiographs. They subsequently took part in a seminar about variations in perception and judgement and were given explanations of sensitivity, specificity and receiver operating characteristic (ROC) curve analysis. A repeat reading of the radiographs was then performed by both test and control groups. Results indicated that the intervention increased the accuracy, and decreased the variability of dentists' restorative treatment decisions. Kappa statistics were 0.33, 0.34 and 0.31 before the seminar, and 0.40, 0.43 and 0.41 after the seminar. Standard errors for kappas were 0.06, 0.05 and 0.05 before the seminar, and 0.02, 0.02 and 0.05 after the seminar. The area under the ROC curve was 0.7136 before the seminar and 0.7835 after the seminar. The data demonstrate that the dentists' decisions were less variable and more accurate following the educative intervention. This study suggests that there is potential for improving consistency and accuracy in clinical decision-making through education in probabilistic reasoning.

Design, development and validity testing of the gang affiliation risk measure (GARM)

“…The two ROC curves can be seen in Figures 1 and 2. Both of these curves are above the diagonal 'line,' and have a highly significant (p < 0.01) area under the curve (AUC) of .78 and .89 respectively, which classify this a 'good' and 'very good' discriminatory measure (Choi, 1998). These results support the discriminative ability of GARM as a measure of gang affiliation.…”

Dental caries paradigms in diagnosis and diagnostic research

“…The tentative explanations for this change included an in‐service lecture programme on the prognosis of approximal caries lesions coupled with increasing numbers of patients per dentist, demands for increasing productivity, and more delayed or postponed recall appointments. Taken together, these factors seem to have increasingly pushed dentists to adopt a let‐us‐observe attitude and, not least, to tolerate uncertainty (173), an interpretation that is corroborated by the results of other studies (174). While it may seem quite paradoxical that learning about uncertainty will enhance consistency, there are analogous examples from other branches of dentistry illustrating that clinical experience and expertise does not guarantee the most consistent diagnoses.…”

Caries management: technical solutions to biological problems or evidence‐based care?

“…Similar changes in the restorative treatment strategies have been described for Norwegian populations (7), and were ascribed to an in-service lecture programme about the prognosis of approximal caries lesions, as well as an increasing demand for productivity (number of patients seen per dentist), which may have reduced the propensity to perform restorations. The potential for change is further illustrated by research showing that teaching practitioners about uncertainty in diagnosis and the costs and benefits of action versus no action results in improved consistency and accuracy in caries-related clinical decision-making (96).…”