Do physicians know when their diagnoses are correct? Implications for decision support and error reduction.

Objective: This study explores the alignment between physicians' confidence in their diagnoses and the "correctness" of these diagnoses, as a function of clinical experience, and whether subjects were prone to over-or underconfidence.

Design: Prospective, counterbalanced experimental design.

Setting: Laboratory study conducted under controlled conditions at three academic medical centers.

Exploring the boundaries of plausibility: empirical study of a key problem in the design of computer-based clinical simulations.

All clinical simulation designers face the problem of identifying the plausible diagnostic and management options to include in their simulation models. This study explores the number of plausible diagnoses that exist for a given case, and how many subjects must work up a case before all plausible diagnoses are identified. Data derive from 144 residents and faculty physicians from 3 medical centers, each of whom worked 9 diagnostically challenging cases selected from a set of 36.