Tips for Teachers of Evidence-based Medicine: Making Sense of Decision Analysis Using a Decision Tree

被引:14
作者
Lee, Anna [1 ]
Joynt, Gavin M. [1 ]
Ho, Anthony M. H. [1 ]
Keitz, Sheri [2 ]
McGinn, Thomas [3 ]
Wyer, Peter C. [4 ]
机构
[1] Chinese Univ Hong Kong, Dept Anaesthesia & Intens Care, Prince Wales Hosp, Hong Kong, Hong Kong, Peoples R China
[2] Univ Miami, Miller Sch Med, Miami Vet Affairs Med Ctr, Miami, FL 33136 USA
[3] Mt Sinai Med Ctr, New York, NY 10029 USA
[4] Columbia Univ Coll Phys & Surg, New York, NY 10032 USA
关键词
tips; clinical learners; evidence-based medicine; decision analysis; USERS GUIDES;
D O I
10.1007/s11606-009-0918-8
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
Decision analysis is a tool that clinicians can use to choose an option that maximizes the overall net benefit to a patient. It is an explicit, quantitative, and systematic approach to decision making under conditions of uncertainty. In this article, we present two teaching tips aimed at helping clinical learners understand the use and relevance of decision analysis. The first tip demonstrates the structure of a decision tree. With this tree, a clinician may identify the optimal choice among complicated options by calculating probabilities of events and incorporating patient valuations of possible outcomes. The second tip demonstrates how to address uncertainty regarding the estimates used in a decision tree. We field tested the tips twice with interns and senior residents. Teacher preparatory time was approximately 90 minutes. The field test utilized a board and a calculator. Two handouts were prepared. Learners identified the importance of incorporating values into the decision-making process as well as the role of uncertainty. The educational objectives appeared to be reached. These teaching tips introduce clinical learners to decision analysis in a fashion aimed to illustrate principles of clinical reasoning and how patient values can be actively incorporated into complex decision making.
引用
收藏
页码:642 / 648
页数:7
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