MHPE 494 - Medical Decision Making

Course Syllabus and Notes

Arthur Elstein and Alan Schwartz

Course Faculty

Department of Medical Education

College of Medicine, University of Illinois at Chicago

Arthur Elstein, Professor, Department of Medical Education, College of Medicine, University of Illinois at Chicago, 808 S. Wood (M/C 591), Chicago, IL 60612-7309; Room 986-A; Tel: 312-996-5451; Fax: 312-413-2048; E-mail: aelstein@uic.edu

Alan Schwartz, Assistant Professor, Department of Medical Education, College of Medicine, University of Illinois at Chicago, 808 S. Wood (M/C 591), Chicago, IL 60612-7309; Room 976; Tel: 312-996-2070; Fax: 312-413-2048; E-mail: alansz@uic.edu

The goal of this one-week intensive course is to introduce students to the basics of medical decision making, including interpretation of diagnostic tests, assessment of patient preferences, integration of uncertainties and preferences, cost-effectiveness, clinical scoring rules, and ethical issues in medical decision making.

Course Objectives

Upon completion, the student will be able to:
  1. Determine the statistical properties of diagnostic tests, appropriately select tests, and appropriately revise his/her estimate of the probability of a disease given a test result
  2. Recognize the role of patient preferences in decision making, and understand how preferences can be measured and integrated into decisions along with probabilities
  3. Read and interpret a decision analysis or cost-effectiveness analysis
  4. Explain the basis of a clinical scoring rule and compare it to unaided clinical judgment
  5. Discuss the ethical implications of decision analysis

Schedule and assignments:

Assignments

 

Mornings (9:00 - noon)

 

Afternoons (1:00 - 4:00)

Day 1:
Read Sackett; Dawson & Arkes

9:00
9:20
10:00
 
11:00
11:45

Introduction
Lect: Diagnostic tests
Sg: Diagnostic test exercise
Pl: Discuss exercise
Ind: Decision survey
1:00
1:45
 
2:30
3:15
Pl: Decision psychology
Sg: Find properties of tests
Lect: Bayes theorem
Sg: Online Nomogram

Day 2:
Read Froberg & Kane; Hodder, et al.

9:00
9:15
 
9:30
 
10:00
11:00

Pl: Report on findings
Pl: Why measure preferences?
Video: Breast cancer prefs
Sg: Utility assessments
Pl: Discuss assessments

1:00
 
1:30
2:30
3:15

Lect: Multi-attribute utility theory
Sg: MAUT exercise
Pl: Discuss exercise
Sg: Find a utility-driven decision in your field

Day 3:
Read Rouse & Owen; O'Meara, et al.; Sonnenberg & Beck

9:00
10:00
11:00

Pl: Report on findings
Lect: Decision trees
Sg: Find examples of DAs from your field

1:00
2:00
2:45
 
3:30

Pl: Report on findings
Lect: Markov models
Sg: Markov model exercise
Pl: Discuss exercise

Day 4:
Read Eddy; Ebell; Inouye, et al.

9:00
10:00
 
11:00

Lect: Cost-effectiveness
Sg: Find examples of CEA
Pl: Report on findings

1:00
 
2:00
3:00

Lect: Guidelines & scoring rules
Sg: Find examples
Pl: Report on findings

Day 5:
Read Dowie; Ubell

Turn in 2-page letter

9:00
 
10:30
12:00

End of life cases
Pl: Discuss letters
Closure & course evaluation

   
Lect: Lectures on topics by instructors
Sg: Small group activities
Ind: Individual activities
Pl: Plenary sessions: presentations by student groups

Reading List

Most readings are available from the UIC Library's Electronic Reserves, in Adobe Acrobat (PDF) format or from OVID. When printing PDF files, be sure you check the "Fit to Page" checkbox on the printing dialog box, as at least one of the articles is formatted for A4 paper.

Day 1

Day 2

Day 3

Day 4

Day 5

 

Student Assessment:

Group exercises
	Diagnostic tests	5		_____
	Utility assessments	5		_____
	MAUT			5		_____
	Markov models		5		_____
	Case  			5		_____	(25) _____

Presentation/Participation				(50) _____

Letter to Dean   					(25) _____

			Total for 1-credit students:	     _____/100

Final paper (for 2-credit students)			(20) _____

			Total for 2-credit students:         _____/120

Grade:  A (85-100%) B (75-84) C (60-74) E (59 or less)

The Letter to Dean is a 2 page letter that you might send to the Head of your Department, Dean of your College, or similar person, discussing how well your institution supports good clinical decision making, and proposing suggestions to improve clinical decision making.

Students taking the 2-credit version of the course must turn in a paper of no more than 5 pages (double-spaced) reviewing two decision analyses, cost-effectiveness analyses, etc., from their fields, and discussing how these might be useful in informing clinical decision making. The paper is due by October 1, with no exceptions. These students will receive an incomplete for their summer grade, which will be converted to a real grade once the paper is received and graded.

 

Resources and References

Here are additional books and web pages that may be of interest to you.

Medicine

The Society for Medical Decision Making is a society of clinicians, decision analysts, and decision scientists interested in improving decisions about medical care. It hosts an annual meeting and publish the journal Medical Decision Making.

John Clarke's Workshop on Surgical Decision Making is an excellent interactive tutorial on the web at http://www.auhs.edu/cgi-bin/tutorial/tutorial.cgi.

The Evidence-Based Medicine Toolbox at the Center for Evidence-Based Medicine at Oxford has a bunch of web-based explanations of diagnostic testing concepts, along with examples from the literature at http://cebm.jr2.ox.ac.uk/docs/toolbox.html.

Psychology

The Society for Judgment and Decision Making is an academic society, composed mostly of psychologists, that hosts an annual meeting devoted to presentations of research on judgment and decision making.

Business and Public Policy

The Decision Analysis Society of INFORMS maintains an excellent web site devoted to decision analysis.