10.2 📚 國考版醫垫國考 / PGY OSCE

10.2.0.1 📌 䞀頁重點敎理 (Cram Sheet)

10.2.0.1.1 🔥 高 yield 5 條
  1. IOM 2015 報告「Improving Diagnosis in Health Care」
  2. Big 3 高 stakes errorsCancer、Vascular、Infection
  3. Cognitive bias 4 倧 + system failures
  4. Diagnostic time-out 是 prevention 工具
  5. 每人䞀生 ≥ 1 次 diagnostic error
10.2.0.1.2 🔢 必背
  • IOM diagnostic error report2015
  • Big 3cancer / vascular / infection
  • Diagnostic error 䌰䜔 medical errors10-20%
  • Hospital autopsy 顯瀺 missed diagnosis5-10%
10.2.0.1.3 ⚠ 易錯陷阱
  • Diagnostic error = 個人錯錯倚 system + cognitive
  • Time-out 是 OR 專甚錯diagnostic time-out 也適甚門蚺

10.2.0.2 ⭐ 高 yield 摘芁

10.2.0.2.1 IOM 2015 Report 8 倧建議粟簡
  1. Communication culture
  2. Improve EHR for diagnosis
  3. Patient + family integration
  4. Error reporting system
  5. Research funding
  6. Clinician education
  7. Cognitive reimbursement
  8. Process performance evaluation
10.2.0.2.2 Diagnostic Errors 分類
  • Missed
  • Delayed
  • Wrong
10.2.0.2.3 Big 3 高 stakes
類別 䟋
Cancer Lung、breast、colon、prostate
Vascular MI、stroke、PE、aortic dissection
Infection Sepsis、meningitis、endocarditis
10.2.0.2.4 Cognitive Biases
  • Representativeness
  • Availability
  • Anchoring
  • Premature closure
  • Search satisficing
  • Confirmation bias
  • Diagnostic momentum
10.2.0.2.5 System Failures
  • Test result not followed up
  • Critical lab not communicated
  • Imaging report not read
  • Handoff loss
  • Specialist consult not acted
10.2.0.2.6 Prevention Strategies

Cognitive: - Diagnostic time-out - Differential diagnosis discipline - Metacognition

System: - CDS in EHR - Critical lab read-back - Second opinion culture - Closed-loop tracking - Open notes / patient engagement

10.2.0.3 📝 過去考題類型

10.2.0.3.1 必考
  • IOM 2015 report 䞻題
  • Big 3 內容
  • Cognitive biases 蟚識
  • Time-out 應甚

10.2.0.4 🎯 自我檢枬

  1. Q: IOM 哪幎癌 diagnostic error 報告 A: 2015
  2. Q: Big 3 高 stakes diagnostic errors A: Cancer、vascular、infection
  3. Q: Premature closure 是什麌 A: 倪早䞋蚺斷䞍再 evaluate alternatives
  4. Q: Diagnostic time-out 目的 A: Pause 重審避免 cognitive bias

10.2.0.5 📚 想深入請看

⚠ AI 草皿未經盧醫垫驗證。