中国作者重要发表 - 循证医学教师的10个小窍门：采用决策树正确进行决策分析



循证医学教师的10个小窍门：采用决策树正确进行决策分析





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





Lee A., Joynt G.M., Ho A.M.H., Keitz S., McGinn T., Wyer P.C. 2009/5/29 18:39:20

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Journal of General Internal Medicine, 2009, Volume 0,




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. © 2009 Society of General Internal Medicine.



Correspondence Address: Wyer, P.C.; Columbia University College of Physicians and Surgeons, New York City, NY, United States; email: pw91@columbia.edu



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