Tracing the decision-making process of physicians with a Decision Process Matrix

Table 1 Study overview and the four steps of assessing a Decision Process Matrix

Step	Activities	Assessing	Method	Who	Timepoint
1	Observing and recording relevant medical information	Cues	Taking notes	Student	Throughout the entire diagnostic process
2	Assessing options in terms of suspected diagnoses	Options	Open question	Student & resident	Immediately after the initial contact with patient (after MHT/PE)
3	Drawing up an initial version of the DPM	Raw version of DPM	Transferring cues and options	Student	Between MHT/PE and waiting for I&LT
4	Verifying and completing the DPM and finally adding of confidence ratings	Final versions incl. numbering and confidence ratings	Thinking aloud, reference scale	Resident & student	Directly after the discharge of the patient

The naturalistic decision-making process of 11 residents and a total of 55 medical cases were recorded in a emergency department. For each medical case a Decision Process Matrix [DPM] was drawn up according to a semi-structured technique following steps 1–4. For each step the activities, assessed parts of the DPM, method used, person(s) involved, and timepoint during the diagnostic process are indicated. Resident and student both had to agree in the final DPM. Further abbreviations: MHT, medical history-taking; PE, physical examination; I&LT, imaging and laboratory tests

ISSN: 1472-6947