Diagnostic errors are a major, largely preventable, patient safety concern. Error interventions cannot feasibly be implemented for every patient that is seen. To identify cases at high risk of error, clinicians should have a good calibration between their perceived and actual accuracy. This experiment studied the impact of feedback on medical interns' calibration and diagnostic process. In a two-phase experiment, 125 medical interns from Dutch University Medical Centers were randomized to receive no feedback (control), feedback on their accuracy (performance feedback), or feedback with additional information on why a certain diagnosis was correct (information feedback) on 20 chest X-rays they diagnosed in a feedback phase. A test phase immediately followed this phase and had all interns diagnose an additional 10 X-rays without feedback. Outcome measures were confidence-accuracy calibration, diagnostic accuracy, confidence, and time to diagnose. Both feedback types improved overall confidence-accuracy calibration (R2No Feedback = 0.05, R2Performance Feedback = 0.12, R2Information Feedback = 0.19), in line with the individual improvements in diagnostic accuracy and confidence. We also report secondary analyses to examine how case difficulty affected calibration. Time to diagnose did not differ between conditions. Feedback improved interns' calibration. However, it is unclear whether this improvement reflects better confidence estimates or an improvement in accuracy. Future research should examine more experienced participants and non-visual specialties. Our results suggest that feedback is an effective intervention that could be beneficial as a tool to improve calibration, especially in cases that are not too difficult for learners.

中文翻译：

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绩效和信息反馈对医学实习生信心-准确性校准的影响。

诊断错误是一个主要的、很大程度上可以预防的患者安全问题。不可能对每个就诊的患者实施错误干预。为了识别错误风险高的病例，临床医生应该在他们的感知准确性和实际准确性之间进行良好的校准。本实验研究了反馈对医学实习生校准和诊断过程的影响。在一个两阶段实验中，来自荷兰大学医学中心的 125 名医学实习生被随机分配接受无反馈（控制）、关于他们的准确性的反馈（绩效反馈），或关于为什么特定诊断是正确的附加信息的反馈（信息反馈）他们在反馈阶段诊断了 20 次胸部 X 光片。测试阶段紧接着这个阶段，让所有实习生在没有反馈的情况下诊断另外 10 次 X 光片。结果测量是置信度-准确度校准、诊断准确度、置信度和诊断时间。两种反馈类型都提高了整体置信度-准确性校准（R2No Feedback = 0.05，R2Performance Feedback = 0.12，R2Information Feedback = 0.19），这与诊断准确性和置信度的个别改进一致。我们还报告了二次分析，以检查案例难度如何影响校准。诊断时间在不同情况下没有差异。反馈改进了实习生的校准。然而，尚不清楚这种改进是否反映了更好的置信度估计或准确性的提高。未来的研究应该检查更有经验的参与者和非视觉专业。我们的结果表明，反馈是一种有效的干预措施，作为改进校准的工具可能是有益的，