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Essex B, Healy M. Evaluation of a rule base for decision making in general practice. Br J Gen Pract. 1994;44(382):211-3
Essex, B., & Healy, M. (1994). Evaluation of a rule base for decision making in general practice. The British journal of general practice : the journal of the Royal College of General Practitioners, 44(382), 211-3.
Essex, B, and Healy, M. "Evaluation of a rule base for decision making in general practice." The British journal of general practice : the journal of the Royal College of General Practitioners vol. 44,382 (1994): 211-3.
Essex B, Healy M. Evaluation of a rule base for decision making in general practice. Br J Gen Pract. 1994 May;44(382):211-3. PMID: 8204334; PMCID: PMC1238868.
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Br J Gen Pract. 1994 May;44(382):211-3.

Evaluation of a rule base for decision making in general practice.

The British journal of general practice : the journal of the Royal College of General Practitioners

B Essex, M Healy

Affiliations

  1. University of London Institute of Education.

PMID: 8204334 PMCID: PMC1238868
Free PMC Article

Abstract

BACKGROUND: Decision making in general practice relies heavily on judgmental expertise. It should be possible to codify this expertise into rules and principles.

AIM: A study was undertaken to evaluate the effectiveness, of rules from a rule base designed to improve students' and trainees' management decisions relating to patients seen in general practice.

METHOD: The rule base was developed after studying decisions about and management of thousands of patients seen in one general practice over an eight year period. Vignettes were presented to 93 fourth year medical students and 179 general practitioner trainees. They recorded their perception and management of each case before and after being presented with a selection of relevant rules. Participants also commented on their level of agreement with each of the rules provided with the vignettes. A panel of five independent assessors then rated as good, acceptable or poor, the participants' perception and management of each case before and after seeing the rules.

RESULTS: Exposure to a few selected rules of thumb improved the problem perception and management decisions of both undergraduates and trainees. The degree of improvement was not related to previous experience or to the stated level of agreement with the proposed rules. The assessors identified difficulties students and trainees experienced in changing their perceptions and management decisions when the rules suggested options they had not considered.

CONCLUSION: The rules developed to improve decision making skills in general practice are effective when used with vignettes. The next phase is to transform the rule base into an expert system to train students and doctors to acquire decision making skills. It could also be used to provide decision support when confronted with difficult management decisions in general practice.

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